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A PRACTICAL TREATISE 



ON 



Typhoid and All Other Slow 

Fevers 

Broken in Fourteen Days 



W; 



BY 

F. HOOPER, M.D. 




BOONEVILLE, ARK. 

THE BOONEVILLE INCORPORATED BOOK COMPANY 



1 



Copyright, 1910 

BY 

THE BOONEVILLE BOOK COMPANY INCORPORATED 



PRESS OF 

F. A. DAVIS COMPANY 

PRINTERS AND PUBLISHERS 

PHILADELPHIA. PENNA. 



CCU280397 



PREFACE 



As the writer has so greatly lessened the mortality, and 
shortened the duration of typhoid fever than as given in text- 
books, he has for this reason set this work before the public. 

The reader is requested to examine the chapter on the 
treatment and formulas at the close of the book before begin- 
ning to read the work. 

In order to clearly set forth the basis upon which this 
work is founded, namely, the vaso-motor capillary systems and 
the sympathetic nervous system, the author has quoted the 
direct words of the American Text-book of Physiology, and 
also from Hare on Practical Therapeutics. 

And in order for the author to prove or disapprove his 
own ideas, he has also quoted some of the exact words of 
Nothnagel and Osier themselves. In order to prove that 
some of the commonly accepted ideas of Osier and Xothnagel 
are illogical and erroneous, the author has quoted a few of 
the exact words of these authors. 

The author is greatly indebted to Hektoen and Riesman 
for their ideas, as seen in their work on Pathology as pertain- 
ing to the probability of the typhoid bacilli being nothing 
more than a rejuvenated colon bacilli. 

Though the writer has unhesitatingly criticised the con- 
flicting ideas of Osier and Xothnagel, such criticism, how- 
ever, is solely from the firm conviction that their conclusions 
in these instances are illogical. But the writer must acknowl- 
edge his indebtedness to the assistance their work gave him 
on both Typhoid and Malarial Fevers. 

iii 



SUMMARY. 



As so much already has been written on micro-organisms 
as the direct cause of all acute inflammatory diseases, I shall 
describe these fevers largely from a practical, clinical, thera- 
peutic and prognostic standpoint. I propose to show a still 
deeper, underlying cause than mere micro-organisms as the 
cause of acute inflammatory diseases, namely: The Faulty 
Actions of the Yaso-motor Capillary Systems, the Laws of 
Diffusion, and the Abnormal Isotonic Conditions of the Blood. 

In this work I shall briefly refer to the Yaso-motor Sys- 
tems, the Laws of Diffusion, and the Lack of the Isotonic Con- 
ditions of the Blood. And in order to more clearly show how 
to abort Slow Fevers, it is necessary to minutely describe 
Malaria. After considering Malaria from a morphological 
standpoint, I shall show a still deeper, underlying cause than 
Malarial parasites, namely, the Faulty Action of the Yaso- 
motor System and the Lack of the Isotonic Conditions of the 
Blood. 

I shall give the divisions of Malarial Fevers first from a 
morphological standpoint, as given by Xothnagel and Osier, 
in order to clearly show that their divisions are not upon a 
clearly defined logical basis. For I propose to show that 
though these eminent observers have fully agreed, morpho- 
logically, a*^ to the divisions of these fevers, nevertheless they 
hold distinctly opposite views from each other as to whether or 
not all forms of Malarial Fevers may be aborted with the use 
of quinine. And I shall further show that these eminent ob- 
servers not only contradict each other's views concerning 
Malarial Fevers, but they even contradict their own statements. 

I shall then call the attention of the reader to the 
importance of rejecting the mere statements even of eminent 
observers, unless to such statements are added logical reasons 
for saying that their ideas are absolutely correct. 

v 



vi Summary. 



After giving many reasons why a division of Malarial 
Fevers, from a morphological standpoint, is not a good one, I 
then proceed to show how Malarial Fevers may be divided 
from a practical, clinical and prognostic standpoint. And in 
the classification of Malarial Fevers, I divide and describe only 
those types of fevers that can be diagnosed at a glance as 
some type of Malarial Fever. For this reason I do not 
describe Estivio-autumnal Fevers under the head of Malarial 
Fevers. 

I then proceed to show why Estivio-autumnal and Typhoid 
Fevers should both be described under the head of Slow 
Fevers. And in order to prove this statement, I propose to 
show that there are no clearly defined diagnostic signs between 
Estivo-autumnal and Typhoid Fever. 

For I propose to show that there is no especial diagnostic 
importance in Typhoid Fever of the following signs : The 
typhoid tongue, rose-colored spots, stepladder-like ascent of 
the daily rise of the temperature, inflammation of "Peyer's 
Patches," diarrhoea, the mere fact that the quinine will not 
abort the fever, the diazo-reaction test, Widal Test, and hem- 
orrhage of the bowels. And I propose to show that the mere 
presence of typhoid bacilli in the blood is no absolute proof that 
the disease is Typhoid Fever ; for I propose to show that there 
is a probability that the so-called typhoid bacilli are nothing 
more than rejuvenated colon bacilli. 

Then I propose to show that the mere presence or ab- 
sence of Malarial Parasites in the blood is no absolute, diag- 
nostic certainty that the disease is Malarial Fever. And for 
this reason, the mere presence of Malarial Parasites is no ab- 
solute evidence that the disease is Estivo-autumnal Fever. 

I then still further proceed to show from a practical, 
clinical, therapeutic and prognostic standpoint that it is better 
to classify Estivo-autumnal and Typhoid Fevers both under the 
head of "Slow Fever." 

In order to clearly show how to abort slow fevers in four- 
teen days, and to do this with a minimum mortality, it is neces- 
sary to briefly describe some of the common remedies used in 
aborting slow fevers. 

Therefore, I shall go into minute details to show just 



Summary. vii 



when calomel is indicated and when contraindicated. I shall 
show when digitalis, gelsemium, aconite, and veratrum are 
indicated and when contraindicated under given connditions. 
Furthermore, I shall show when quinine, strychnine, atropia, 
arsenic, salol, nitro-glycerine, sweet spirits of nitre, and other 
common remedies, are indicated and when contraindicated. 

I further propose to show that it is absolutely necessary 
to divide slow fevers into types according to their grades of 
severity. And I further propose to show that the grades of 
severity increase according to the involvement of the intestinal 
canal from within outward. And I shall further subdivide 
these types into different grades of severity. Furthermore, I 
shall consider involvement of tissues in a longitudinal direc- 
tion as sequela. The sequela will also be minutely described, 
and the different grades of severity will be described. And 
in this work I shall consider all those diseases that are carried 
by reflex irritation as complications. And these complications 
will be minutely described. I divide these fevers in this way 
distinctly from a clinical, practical, therapeutic and prognostic 
standpoint ; for only in this way can slow fevers be succeess- 
fully managed. 

Before taking up the minute details of the various types 
and grades with their complications and sequela, I shall in this 
work lay out a broad, general plan to show how to pretty 
well tell how to determine the tissue of the intestinal canal 
involved from the objective and subjective symptoms alone. 
I shall further proceed to tell just how to detect a threatened 
reflex irritation, and how to prevent such a complication. In 
fact, a broacl general outline will be given, in order to thor- 
oughly understand how to diagnose and successfully manage 
all forms, types, complications and sequela of slow fevers. 

In order to more clearly set forth just how to success- 
fully manage slow fevers, with their sequela and complications, 
I have given one or more clinical cases in every grade treated. 

Then I have minutely described acute enteritis and acute 
dysentery. And I have further described acute diseases that 
may result from the absorption of poison during the inflam- 
matory stages of acute inflammatory diseases, namely, Acute 
Osteo-mvelitis and Acute Uraemia. 



SECTION I 



CHAPTER I. 
INTRODUCTION. 

The Vaso-motor Capillary Systems* In 1840 Henle 
demonstrated the existence of muscular fibres in the middle 
coats of the arteries. Later Henle said : 'The part taken by 
the contractility of the heart and the blood vessels may be 
summed up in two words : the movement of the blood de- 
pends upon the heart, but its distribution depends upon the 
blood vessels.'' Later Henle further declared that the vessels 
contract because their nerves are stimulated either directly or 
reflexly through the agency of a sensory apparatus. And, still 
later, Schiff, Bernard, Brown, Scquard and Waller demon- 
strated and established the fact of the existence of nerve fibres, 
the stimulation of which causes constriction of the blood ves- 
sels to which they are distributed. In 1856 these men showed 
that there were present also vaso-motor nerves. 

"The three classes of nerve cells. It is now known 
that the vaso-motor apparatus consists of three classes of 
nerve cells/ The cell bodies of the first class lie wholly 
within the sympathetic ganglia, their neuraxons (axis cylin- 
der processes) passing directly to the smooth muscles in the 
walls of the blood vessels. The cell bodies of the second 
class are situated at different levels in the cerebro-spinal axis. 
their neuraxons passing thence to the sympathetic ganglia by 
way of the spinal and cranial nerves ; and so lie partly within 
and partly without the other two classes. And the cell bodies 
of the third class are placed in the bulb and control the sec- 



* Taken from Howell in " American Text-Book of Physiology." 



Typhoid and Other Fevers. 



ond, through intra-spinal and intra-cranial paths, the third 
class lying wholly within the cerebro-spinal axis. 

And here in this connection it might be said that the por- 
tal circulation is so connected that changes in the calibre of 
the blood vessels may alter the quantity of the blood in the 
lungs. 

"The Vaso-dilator and Constrictor Nerves. It was later 
ascertained that the walls of the blood vessels were controlled 
by nerves that determine the amount of blood flow to the 
blood vessels. When these nerves are stimulated, they either 
narrow the blood vessels or constrict them. Those nerves 
that dilate the internal blood vessels, thus naturally causing 
more or less constriction of the peripheral blood vessels, are 
called "Vaso-dilator nerves." Those nerves that constrict the 
internal blood vessels, thus naturally causing more or less dila- 
tion of the peripheral blood-vessels, "are called vasoconstric- 
tor nerves." 

Concerning the Vaso-motor system Hare says : "I am 
convinced that the importance of considering the condition 
of the vaso-motor system is not appreciated. Either it is 
ignored entirely, or it is spoken of indefinitely in much the 
same way that some practitioners refer to the sympathetic 
system as the cause of an ailment, probably because it is the 
simplest way of admitting that they do not know what they 
are talking about. In reality we may, in view of our knowl- 
edge of the functions of the vaso-motor system, assert .that 
its integrity is as necessary to life as is the integrity of the 
heart — the organ to which we pay so much attention in every 
case we see. A heart may be lamed, yet the man live com- 
fortably; whereas an ill-conditioned vaso-motor system will 
at once cause distress. This system is made up* on the one 
hand of the vaso-motor nervous apparatus, and on the other 
of the blood vessels themselves. 

"It must be remembered that the tonicity of the arterioles 
and capillaries offers a resistance to the action of the heart 
which is as natural as is the atmospheric pressure of fifteen 
pounds to the square inch on our bodies or in our lungs, and 
that any variation in this resistance by reason of dilatation or 



Introduction. 



contraction of the blood vessels is followed by as definite 
symptoms as ensue when we expose ourselves to rarified air 
on the one hand, or to compressed air on the other. The 
resistance offered to the heart by the properly acting vaso- 
motor nervous system, through its influence on the vessels, 
is identical with the friction offered to the driving-wheels of 
a locomotive. The locomotive is meant to meet and stand 
the resistance, and if the resistance is removed by slippery 
rails the wheels fly around ineffectually, racking the machinery 
and destroying its usefulness. On the other hand, if the hill 
be too steep, the resistance is too great, and the engine comes 
to a standstill or blows out a cylinder-head, though before 
such a thing occurs the mechanism is much embarrassed, as is 
evidenced by the heaving impulses of the draught. 

"From this we learn some important diagnostic and ther- 
apeutic facts : First, that a rapid pulse may be due in no way 
to a disordered heart, but be due to a vaso-motor relaxation ; 
and second, that the proper way of treating the pulse is to put 
sand on the track and increase the resistance, and not to make 
more steam — or give digitalis — which will only make the en- 
gine, or heart, work away on slippery rails with more wear 
and tear and make no progress. Conversely, if a heart seems 
to be laboring against a high arterial pressure, the most sen- 
sible thing for us to do is not to stimulate this organ to in- 
creased and exhausting effort, but to eliminate the resistance 
offered by the grade by making a cut through which the heart 
may pump its way with normal resistance. This we do by the 
use of vaso-motor relaxants, such as nitrites, or by bleeding. 
Much of the reputation of nitro-glycerine as a cardiac stim- 
ulant rests on the fact that under its influence excessive arte- 
rial resistance is removed, and the heart has a chance to per- 
form its work properly without direct stimulation. When we 
consider the enormous space offered by the capillary area 
when it is relaxed for the flow of blood or its stagnation, the 
facts I am endeavoring to emphasize become even more im- 
pressive. It seems proper, therefore, that in every case to 
which we are called we should examine the tension of the 
blood vessels before prescribing for the heart itself." 



Typhoid and Other Fevers. 



Laws of diffusion* "When two gases are brought 
into contact, a homogeneous mixture of the two results. This 
interpenetration of the gases is spoken of as diffusion, which 
is due to the continuous movements of the gaseous molecules 
to and fro within the limits of the combining space. Also for 
the same reasons, when two miscible liquids or solutions are 
brought into contact, a diffusion occurs, the movement of the 
molecules finally affecting a homogeneous mixture. If the 
two liquids happen to be separated by a membrane, diffusion 
will still occur, provided the membrane is permeable to the 
liquid molecules, and in time the two liquids on the two sides 
will be mixtures having a uniform composition. Not only 
the water molecules, but the molecules of many substances in 
solution, as sugar, carbonate of soda and chloride of soda, 
may pass to and fro through membranes, so that two liquids 
separated from each other by an intervening membrane, and 
originally unlike in composition, may finally, by the act of 
diffusion, come to have the same composition. Diffusion of 
this kind through a membrane is frequently spoken of as 
dialysis, or osmosis. In the body we deal with aqueous 
solutions of various substances that are separated from one 
another by living membranes such as the walls of blood ves- 
sels, capillaries, or of the alimentary canal. And the laws 
of diffusion are of immediate importance in explaining the 
passage of water and dissolved substances through these liv- 
ing septa. In aqueous solutions such as we have in the body 
we must take into account the movement of the molecules of 
the solvent, water, as well as the substances dissolved. These 
latter may have different degrees of diffusibility as compared 
with one another or with the water molecules; and it fre- 
quently happens that a membrane that is permeable to water 
is less permeable to the molecules of the substance in solu- 
tion. For this reason the diffusion stream of water and of 
the dissolved substance may be differentiated, as it were, to a 
greater or lesser extent. It is now the custom to limit the 
term osmosis to the stream of water molecules passing through 



Taken from " Howell on Physiology. 



Introduction. 



a membrane, while the term dialysis, or diffusion, is applied 
to the passage of molecules of the substance in solution. 

"Osmotic Pressure. The osmotic stream of water under 
varying conditions is especially important, and in connection 
with the process it is necessary to define the term osmotic pres- 
sure. Let us imagine two masses of water separated by a per- 
meable membrane, we can readily understand that as many 
water molecules will pass through from one side as from the 
other ; the two streams, in fact, will neutralize each other, and 
the volumes of the two masses of water will remain unchanged. 
The movement of the water is not actually observed, but it is 
assumed to take place on the theory that the liquid molecules 
are continually in motion, and that the membrane, being per- 
meable, offers no obstacles to their movements. If now on 
one side of a membrane we place a solution of some crystal- 
loid substance, as salt, and on the other side pure water, then 
it will be found that an excess of water will pass from the 
water side containing the salt solution. So it is seen that the 
salt in solution exerts a certain osmotic pressure, in conse- 
quence of which more water flows from the water side to the 
side of the solution than in the reverse direction. As a matter 
of experiment it is found that the osmotic pressure varies 
with the amount of the substance in solution. 

"Isotonic Solutions. It appears that the liquid surround- 
ing the corpuscles must have a certain concentration as re- 
gards salts or other soluble substances, such as sugar, in order 
to prevent the entrance of water into the substance of the 
corpuscle. Normally the substance of the red blood corpuscle 
possesses a certain osmotic pressure, which is supposed to be 
equal to that of the plasma by which it is surrounded, so that 
the interchange of water between is at an equilibrium. If the 
concentration of this outside liquid is diminished, this equi- 
librium is destroyed and water passes into the corpuscles; if 
the dilution has been sufficient, enough water passes into the 
corpuscle to make it swell and eventually to force out the 
haemoglobin. Such liquids contain inorganic salts or other 
soluble substances that possess an osmotic pressure sufficient 
to prevent the imbibition of water by the corpuscles. Red 



Typhoid and Other Fevers. 



corpuscles suspended in such liquids do not change their shape 
nor lose their haemoglobin. When solutions of different sub- 
stances are compared from this standpoint, it is found that the 
concentration necessary varies with the substance used. Thus 
a solution of soda chloride .64 per cent, is isotonic with a solu- 
tion of sugar of 5.5 per cent., or a solution of nitrate of potas- 
sium of 1.09 per cent. When placed in any of these three 
solutions, red blood corpuscles do not take up water at least in 
sufficient amount to discharge the haemoglobin. 



CHAPTER II. 

ACUTE INFLAMMATORY DISEASES. 

Acute inflammatory diseases named from the location of 
the malady. Most diseases have been named from the location 
of the inflammatory product rather than from the micro-or- 
ganism causing the disease, such a condition resulting in the 
more or less sudden flow of blood to the affected area. For 
instance, any more or less sudden flow of blood to the bron- 
chial tubes is called bronchitis; to the lungs, pneumonia; to 
the meninges, meningitis; to the stomach, gastritis; to the 
region of the kidney, under the name of nephritis, or if very 
severe grade, hematurea or hemoglobinuria; to the intestinal 
tract, under the name of typhoid, malarial, enteritis, dysentery, 
etc. ; and many other diseases are named in the same way. 
The more or less rapid flow of blood to the affected area usually 
produces a chill or rigor. 

Symptoms. There is usually a chill or rigor in all forms 
of acute inflammatory diseases; in some forms the disease is 
ushered in with the hot stage. The first stage is quickly fol- 
lowed by the hot stage. After the hot stage the third stage 
begins. 

Etiology. Although it is considered to be absolutely cer- 
tain that all acute inflammatory diseases are due to some form 
of micro-organisrn, however, this assertion cannot be absolutely 
proven, for there is a probability that the micro-organisms in 
these diseases are rather the result of the increased flow of 
blood, causing the inflammation of the affected region which 
furnished food for the micro-organisms. 

It is not clear that micro-organisms are the sole cause of 
acute inflammatory diseases for the following reasons : For 
instance, it cannot be known, absolutely, that microbes are the 
cause of pneumonia, for these micro-organisms are often found 
in the air passages in health; and so if found in health, their 
presence in disease is of no especial diagnostic import. Then, 
too, it is admitted by all scientific men that the micro-organisms 

(7) 



8 Typhoid and Other Fevers. 

may be -lodged in a healthy individual with sufficient resistive 
power without any evil effects. Is it not only reasonable 
to decide that lying on a damp, cold ground, sitting in a cold 
room, or getting wet feet, rather is a direct cause of bron- 
chitis, rhinitis and pneumonia, thus causing an abnormal flow 
of blood to the affected area rather than micro-organisms that 
often are found in health? 

So there must be a deeper, underlying cause for acute 
inflammatory diseases than mere micro-organisms, namely, 
a faulty vaso-motor system. 

Therefore, in order to be in good health, we may con- 
clude from what has already been said that so long as there 
is an isotonic condition between the corpuscles of the blood 
and its outer blood plasma, and so long as the capillary and 
vaso-motor systems are in perfect working order, just so long 
will a person remain in good health. For even if a person 
who is in good health be exposed to irritants from without or 
within, such irritation in an ordinary amount will not affect 
him so long as his vaso-motor and capillary systems keep in 
co-ordination with each other. Under such conditions his 
system is able to keep the blood flow in different portions of 
the body at a normal equilibrium. 

But when the vaso-dilators and vaso-constrictors become 
unduly irritated by some irritation from without or within, 
as a result, blood flows toward the internal surface of the 
body, or at least to the affected area; in such cases, then, on 
account of the overheat production with lessened heat dissi- 
pation, there is more or less rapid rise of temperature. In 
this way the fever occurs. 

As we name diseases from the location of the inflam- 
mation, then it is evident that acute diseases are named largely 
from the location of the disease rather than from the para- 
satology of the disease. 

On reflection it is evident that there is a much closer re- 
lationship existing between all acute inflammatory diseases 
than is generally supposed to exist between them. But in 
this work we shall minutely describe only the acute inflam- 
matory diseases that have their origin in the intestinal canal. 
These diseases now will be described. 



SECTION II 



CHAPTER I 



MALARIA. 



Etiology. Formerly it was supposed that Malaria was 
carried to persons through drinking water. But this theory 
is now entirely discarded. But it is possible in some cases 
that malarial poison may enter the alimentary canal through 
drinking water. Such a thing is possible from the fact that 
the mucous membrane of the alimentary canal in malarial 
fevers is usually more or less inflamed, as is often shown by the 
vomiting of bile, which shows inflammation in the region of 
the bile ducts. In the next place, any close observer who has 
always lived in a malarial district has often noticed that 
chills and malarial fevers are much more common among 
those who habitually drink stagnant water or impure well 
water. In such cases, however, instead of the malarial par- 
asites developing in from eight to fourteen days, it takes 
some months for them to develop. I have often found pa- 
tients ill of some grade of malarial fever whose illness could 
be plainly traced from their swimming in stagnant water. 

Air theory. The oldest theory was the supposition that 
malarial parasites rise from the soil into the air, and gain 
entrance into the respiratory tract. But this theory has been 
entirely abandoned. Nevertheless, anyone who lives in an 
intensely malarial district during the summer months may 
sometimes feel the bad effects of the poisonous decaying mat- 
ter. And such persons will always feel much better by going 
for a few weeks to a location of a higher altitude. And, be- 
sides, it is noticed in all grades of malaria that the mucous 
membrane of the respiratory tract is usually more or less in- 
fo) 



io Typhoid and Other Fevers. 

flamed. Then, too, hawking often precedes a bilious attack. 
And, furthermore, acute catarrh in the summer time often 
precedes some grade of malarial fever. All these conditions 
seem to point to the probability that the air in some way may 
transmit poison that later will be carried through sufficient 
different processes to cause some grade of malarial fever. 

Mosquito theory. Then the mosquito theory was brought 
forth. This theory is the one accepted to-day. In favor of 
the "mosquito theory'' isolated experience was adduced to 
show that infection may be avoided in severe malarial regions 
by the use of mosquito nets ; and, also, it is known that a fire 
at hand makes it the less dangerous to sleep at night on a 
damp soil. 

* The mosquito malarial cycle of development. At the 
present time we know that the cycle of development by the 
parasites in the human host is only one in its evolution, the 
other being completed in a second host, the mosquito. In 
the human host, however, the parasite undergoes a compli- 
cated metamorphosis, consisting in growth, reproduction and 
auto-infection of the special cells which furnish its habitat, 
the red blood cells. To one of these asexual cells the fever 
of malaria is charged, called "pyrotogenic," which fevers are 
quartan, tertian and estivo-autumnal fever. 

Besides the pyrotogenic cycles which are brought about 
by the full growth of the parasites, the young parasites, be- 
fore getting their growth, grow into two sexual cells. The 
growth of these two cells requires a new host, the mosquito, 
which completes the growth of the parasites. The male cell, 
is the flagella, which now is in the stomach of the mosquito. 
The male cell, flagella or microgamete, and the female cell, or 
macrogamete, are seen to become free in the gut of the mos- 
quito. Soon the microgamete penetrates the macrogamete, the 
product of the union being a zygote. The zygote becomes en- 
cysted, and is then called an oocyst. Within these develop 
sporoblasts, that give rise without any spores to sporozoites 
(sickle bodies). These eventually leave the mosquito during 



* Taken from Nothnagel. 



Malaria. 1 1 



the act of biting, and infect the fresh blood corpuscles of a 
new host, and so the sexual cycle is complete. 

Nothnagel divides Malarial Fevers from a morpholog- 
ical standpoint as follows : 

x'. "Malarial parasites that sporulate, but do not 

FORM CRESCENTS. 

(x) "The quartan parasite. 

(y) "The tertian parasite. 

y\ Malarial parasites that sporulate and form 

CRESCENTS. 

(x) "Pigmented quotidian. 

(y) "Non-pigmented quotidian. 

(z) Malignant tertian parasite. 

(x') "The -quartan parasite completes its development 
from spore to sporulation in seventy-two hours. In its young 
condition it appears as a non-pigmented organism, looking like 
a small, clear speck in the infected blood corpuscles. It re- 
mains at this stage for twenty-four hours, increasing only a 
little in size. A deposition of pigment then takes place in 
the outer layers of parasites, consisting of very large, dark- 
line granules, which show no movement. With increased 
pigment formation, the parasite loses its slight power of move- 
ment, until it appears as an immotile, spheric body, filling 
from one-third to one-half of the red blood corpuscles ; when, 
especially in unstained preparations, nothing more of the red 
blood corpuscles is visible. It now prepares itself for sporu- 
lation, in that the pigment granules clump themselves com- 
pactly in the centre of the organism, and a spoke-like arrange- 
ment occurs at the periphery of the plasma, which gradually 
extends to the centre. These radial lines becoming gradu- 
ally sharper divide the parasites into a number of segments, 
usually not exceeding ten. These lines broaden into grooves, 
until the segments previously outlined become separated from 
one another as oval organisms, "daisy form." In each of 
these a circumscribed, glistening speck usually appears, which 
represents the nucleus. This gives to the segments the char- 
acter of independent organisms. These fully formed spores 
break apart by rupturing the thin membrane around this. 



12 Typhoid and Other Fevers. 



This completes the life cycle of the parasite. The remaining 
clumps of pigment are carried away by the leucocytes as dead 
matter. 

"The segmentation of the parasite occurs immediately 
after the paroxysm. The sporulation forms may vary more 
or less in shape and size. For instance, it sometimes hap- 
pens that sporulation may occur at a time when sporulation 
has not yet reached the size of a red blood corpuscle. Under 
these circumstances the spores are usually from four to six. 
The infected red blood corpuscles remain unaltered in size 
and shape, or become somewhat smaller without change of 
form. The color of these shrunken, though round, corpus- 
cles is darker than the non-infected. The infected corpuscles 
are not all decolorized or only slightly decolorized ; or, in fact, 
as already mentioned, they become somewhat darker. In 
this they are especially differentiated from the corpuscles in- 
fected with the tertian parasites. So in this type the protru- 
sion of flagella is seldom seen. The course of development 
is more regular than in other species both in the relation of the 
duration of the development and the progress in growth of 
the single individuals. Moreover, sporulation forms are more 
frequently found in the peripheral blood, since the whole 
cycle of development usually takes place within the vascular 
system. 

(y) "Tertian type. The duration of the tertian type re- 
quires forty-eight hours. When first seen within the corpus- 
cle, it appears as a small, somewhat clear spot. In this stage 
it is now pigmented, or contains only extreme, fine pigment 
dust. It possesses a lively, amoeboid movement, readily vis- 
ible for a long time (an hour or more) at the room tempera- 
ture. After the removal of the blood the parasite remains 
at almost this stage, growing gradually for almost twenty- 
four hours. More arid more pigment in the form of fine 
granules and lines collect, particularly of the plasma, when it 
usually manifests a lively, swarming movement. Simulta- 
neously, these lose in color, look pale in comparison with the 
non-infected, and often increase in size. Sporulation takes 
place after a life cycle of about forty-eight hours. At this 



Malaria. 13 



time the parasite has lost its motility, being almost the size 
of a red blood corpuscle. Its host is enlarged and almost 
completely decolorized, and the swarming of the pigment is 
suspended. Segmentation usually takes place as follows: 
While the pigment concentrates itself in the centre of the or- 
ganism as a thick lump, the plasma of the corpuscles breaks 
up into fifteen or twenty round, strongly refractive, small 
spheres (spores). These sometimes arrange themselves reg- 
ularly in two concentric rows, "Golgi's sunflower," but usu- 
ally irregularly, like a mulberry. The spores of the tertian 
parasites are rounder and smaller than the quartan. The most 
characteristic feature in the sporulation of the tertian para- 
site is the large number (fifteen or twenty) of small, round 
spores. As in the quartan, also in the tertian, the act of 
sporulation corresponds to the paroxysm of the fever. 

(y') "Malarial parasites that sporulate and form crescents. 
These parasites are differentiated biologically from the first 
group in that the latter shows only direct sporulation, while 
the former direct sporulation and crescent formation. In the 
kind now under consideration sporulation occurs almost exclu- 
sively in the internal organs. The paroxysms often lack the 
fixed character of those found in the milder intermittents, and 
the chill may be wanting ; of there may be only a slight rigor. 
In the intermittent anticipating forms the fever has a ten- 
dency to recur earlier and remain later on every successive 
recurrence of the onset. But in the intermittents the par- 
oxysms recur at the same time of day on each successive re- 
currence. Such fevers are produced by the rapid evolution 
of several generations of parasites. Parasites occur almost 
exclusively in the internal organs. 

(x) "The pigmented quotidian parasites. These parasites 
describe their cycle within twenty-four hours. It begins as 
a non-pigmented organism. After its .escape as a spore, it 
lives a short time in the plasma and attaches itself to a red 
blood corpuscle. These small organisms are actively amoe- 
boid. In general (as long as they do not go over into the 
ring form with its condition of rest) they are very similar to 
the substance of the red blood corpuscle. 



14 Typhoid and Other Fevers. 

(y) "The unpigmented quotidian parasite also sporulates 
in the internal organs. These forms so closely resemble the 
other forms, except that they contain no pigment, that we shall 
not describe them in minute detail. Suffice it to say that 
sporulation takes place only in the internal organs, and an 
infection must be necessarily severe before the sporulation 
forms appear in the blood. 

(z) "Malignant tertian parasite. This type is considered 
to be due to crescents by Marchiafava and Bignami, but de- 
nied by most authors. 

"The malarial parasites are now placed under the head 
of the protozoa. Merozoites and perozoites indicate biolog- 
ical conditions that are traceable to the vitality of the parent 
forms. Such a condition seems to pervade all kinds of pro- 
tozoa. After a certain number of reproductions by asexual 
formation of merozoites, vitality becomes worn out, and con- 
jugation or union of gametes results, such a union renewing 
vitality. And when such a union takes place after conjuga- 
tion at a time when the vitality is at its maximum, spores 
occur. These spores produce sporozoites, and the sporozoites 
in turn develop into schizontz, which completes the cycle. 

"After conjugation of the gametes takes place, such a 
union results in the formation of spores. Sporozoites are 
produced from the spores when the vitality is at its maximum, 
the sporozoites in turn develop into sporonts, completing its 
cycle. 

"Much confusion to the reader has arisen from calling 
both the asexual reproductions before conjugation and the re- 
production of the gametes after conjugation has taken place 
as simply 'spores.' In order to avoid any confusion as to 
the meaning, it is better to call the binary fission before con- 
jugation as merozoites, and only name the reproductions that 
take place from the male and female cells as "spores." 

"The gametes may be similar to one another, or may be 
sexually differentiated; if the latter, the larger, yolk-stored, 
quiescent forms are the female parasites or macrogametes. 
After union of the sexual elements, the encysted copula be- 
comes either a single sporoblast, or it divides into two or more 



Malaria. 1 5 



parts, every one of which being sporoblast. Every sporoblast 
may be separated from the others by a special sporocyst, or 
the sporoblast may be reproducing- centres without special 
sporocysts. But in all cases the ultimate reproductive bodies 
are sporozoites, which are usually protected by spore capsules. 

"Differentiation betzveen merozoites and sporozoites. 
The merozoites do not leave the host, but migrate to different 
new localities, where they repeat the process of development 
and sporulation, until they ultimately change into sexually dif- 
ferentiated reproductive bodies. These bodies after fertiliza- 
tion produce the cyst-protected protozoites, which remain qui- 
escent until carried into new hosts. Merozoites thus give rise 
to auto-infection of the host, and sporozoites to fresh infec- 
tion of the new hosts, most frequently by the digestive tract, 
where they are carried with the food. The cysts are then dis- 
solved by the gastric fluids, and the liberated sporozoites 
make their way into the epithelial cells. In general appear- 
ance they closely resemble the merozoites, but usually can be 
distinguished by minor differences, such as general contour, 
presence of pigment, nuclear characteristics, or other features. 

"In the case of Malaria there is one cycle in the human 
host, the asexual cycle. The»asexual cycle occurs in the hu- 
man. In this case the young parasite or trophozoite becomes 
as schizont, a sporulating body, which divides the schizogony 
into a number of merozoites. These merozoites arranged 
around the central lump pigment constitute the 'daisy' or 
'roset' form. They become free in the blood by disintegra- 
tion of the blood cell, and again attack other blood cells, pro- 
ducing auto-infection, and so the asexual cycle is completed. 

"Besides the 'pyrotogenic' cycles, which are brought 
about by the full growth of the parasites, the young parasites 
before getting their growth grow into two sexual cells, the 



male cell or microgamete and the female cell or macrogamete. 
Now the growth of these two requires a new host, the mos- 
quito, which completes the growth of the parasite. The male 
cell or microgamete is the flagella, which is now in the stom- 
ach of the mosquito. The flagella. male cell, or microgamete, 
and the female cell, or macrogamete, are seen to become free 



1 6 Typhoid and Other Fevers. 

in the gut of the mosquito. Soon the male cell penetrates the 
female cell, and the product of the union is a zygote. The 
zygote becomes encysted and is then called an oocyst. Within 
these develop sporoblasts that give rise without any spores to 
sporozoites ('sickle bodies'). These eventually leave the 
mosquito during the act of biting, and infect the fresh blood 
corpuscles of a new host, and so the sexual cycle is complete. 

"The microgametes are active flagellated bodies. It is 
spherical in shape and filled with actively motile pigment. 
This pigment is in the form of small granules, which is dis- 
tributed throughout the organism of the protoplasm of the 
organism. It will be noticed in such round bodies that the 
pigment becomes more and more active, until three or more 
serpentine prolongations appear at the circumference of the 
organism. The prolongations from the protoplasm are from 
three to four times the diameter of the parasite, and possess 
very active, lashing movements. The macrogametes, or fe- 
male cells, are round bodies in which the pigment is collected 
in larger clumps and are generally arranged around the cir- 
cumference in the form of a perfect ring, while there is no 
evidence of motility, being passive organism. A distinct dif- 
ference has been demonstrated between the structure of the 
macrogametes and the microgametes. Jn the macrogametes 
the nucleus is of good size and situated on one side of the 
centre of the organism, and contains a large amount of chro- 
matin. When the flagella, or microgametes, devolop from the 
microgametocyte, it has been demonstrated that the chromatin 
passes into them and forms an essential part of their structure. 

Though the division of Malarial Fevers from a morpho- 
logical standpoint, as given by Nothnagel, is almost identical 
with the division given ' in Osier's works, from a practical 
clinical, therapeutic, and prognostic standpoint, Osier and 
Nothnagel hold distinctly opposite views from each other." 

In order to show that these authors hold distinctly opposite 
views, I shall set forth their own statements. 

In one place Osier says: "Clinically, all estivo-autumnal 
infections should be classed as severe infections, in contradis- 
tinction to the quartan and tertian infections (that don't form 



Malaria. \y 



crescents), which usually are considered as mild infections. 
It must be clearly understood, however, that a quartan or 
tertian may become pernicious, though such instances are rare. 
The old idea that there is a malarial parasite peculiar to the 
pernicious infections is no longer tenable; for it is recognized 
that any of the malarial parasites may produce pernicious 
symptoms, and that the parasites accompanying such infections 
do not differ in any respect from those accompanying the 
mildest infections." Then, in another place of Osier's work, 
he says : "Any one of the malarial plasmodia may give rise 
to the pernicious symptoms. And it should be distinctly under- 
stood that the pernicious forms of malaria depend for their 
etiology upon the same organisms as do the mildest forms." 
But Nothnagel holds a distinctly opposite view from Osier, for 
Nothnagel says : "A beginning has already been made in the 
recognition of the fact that parasites of the first class (non- 
crescent), no matter how strong or numerous the generations, 
scarcely ever produce pernicious fever, and that pernicious- 
ness is almost exclusively confined to the infections caused by 
crescent-forming parasites of the second group." 

Now, though Osier claims that any of the parasites may 
cause pernicious intermittent^, Xothnagel claims that only the 
crescents produce the pernicious form. It is evident, then, that 
no logical conclusions can be drawn by the clinician from such 
contradictory statements. 

And, though Nothnagel declares that the pernicious 
forms of Malaria are due to the crescents, he in another place 
declares that the crescents are found only in the internal 
organs, as in the spleen, and that it is dangerous to puncture 
the spleen in search of parasites. Now, if crescents are found 
only in the internal organs where it is is too dangerous to 
search, it is in such cases impossible not only to know the 
form of malarial parasite, but impossible to absolutely diag- 
nose by the blood that the case is Malarial Fever. And to 
make the diagnosis the more doubtful, Nothnagel says that 
malarial parasites are found in 90 per cent, of the healthy 
children in some parts of Africa. As malarial parasites are 
often found in healthy children, it is impossible to know ab- 
solutely that their presence is the sole cause of the fever. 



t8 Typhoid and Other Fevers. 

Then, too, these authors differ from each other as to 
whether or not quinine may abort Malarial Fevers. Pertain- 
ing to the effect of quinine in treating Malaria, Osier says: 
"Any fever which resists the action of quinine, properly ad- 
ministered, for more than four to five days is not Malarial in 
character." In another place Osier says: "The physician at 
this day who cannot treat Malarial Fever successfully with 
quinine should abandon the practice of medicine." 

Nothnagel contradicts Osier's statements by saying: 
"One form of malarial parasites is totally resistant to qui- 
nine, namely, the crescent. It is the unanimous statement of 
all observers that crescents remain unchanged after the most 
persistent use of quinine, and that the therapy is incapable of 
playing even a prophalactic role, in that relapses occur whether 
or not quinine is exhibited in the apyretical period." 

And after Nothnagel declares that quinine in no way 
aborts the pernicious forms of Malarial Fevers, he makes his 
own statements untenable by what he says further on in his 
work. For he declares that such a pernicious form of Malaria 
as hemoglobinuria should be treated with quinine ; for his own 
words in treating hemoglobinuria are these: "Something 
must be done, and there is no time for experimenting with 
other remedies. Consequently if the symptoms continue to in- 
crease in severity, there is nothing to do but play va banque and 
grasp at quinine." Now, if it were true that quinine has no 
effect on the pernicious forms, he should not more greatly 
jeopardize the life of the patient by giving a useless drug. 
And Nothnagel by his own statement declares that not only 
does quinine have no effect on pernicious Malaria, but often 
causes quinine hemoglobinuria, for he says: "Finally, qui- 
nine plays a very important part. This drug has undoubt- 
edly the power of producing blackwater fever in predisposed 
individuals." If quinine does cause hemoglobinuria, it should 
not be given in that disease. 

Also Osier contradicts his own statements pertaining to 
quinine. For Osier boldly declares that any fever that cannot 
be aborted in four or five days with quinine is Typhoid. But 
he admits that crescents arc rarely found except in the internal 



Malaria. 19 



organs; and he further declares it hazardous to explore the 
internal organs in search of malarial parasites. Therefore 
Osier's statement is untenable; for the malarial parasites at 
that time might possibly be concealed within the internal 
organs. Then, too, in another part of his work he declares 
that the comatose, algid, gastro-enteric forms of Malaria and 
hemoglobinuria always show a very high mortality. Xow, 
if it is really true that any physician at this day who can- 
not treat Malarial Fever successfully with quinine should 
abandon the practice of medicine, why is it that Osier him- 
self failed to successfully manage with quinine these pernicious 
Malarial Fevers? And that Osier aborted every estivo- 
autumnal fever with quinine is an error, for most likely some 
of those fevers diagnosed as Typhoid were some form of Ma- 
larial Fever. 

A morphological division, therefore, is not a good one for 
the following reasons: (1) Even the presence of malarial 
parasites does not absolutely prove that they are the sole cause 
of the fever, for these parasites may be found in health. (2) 
The absence of the crescents in the blood is not an absolute 
sign that the disease is not due to Malaria, for they may be in 
the internal organs ; the probability is that the grades of 
severity of Malarial Fevers 'cannot always be diagnosed by 
the form of the parasite, and, furthermore, many are not pre- 
pared to make the necessary test. 

So, from a practical, clinical, therapeutic prognostic and 
diagnostic standpoint, it is better to divide Malarial Fevers 
into forms that are distinctly and clearly diagnosed as Malaria. 
Such a clear, distinct division of Malarial Fevers will be 
divided into forms according to their well-marked manifesta- 
tions, as seen from their objective and subjective symptoms. 
Therefore, Malarial Fevers may be divided into the following 
different distinct forms : 

(A) Intermittent Fevers. 

(B) Malarial Intermittent Anticipating. 
(O Remittent. 

(D) Double Remittent. 



CHAPTER II. 



INTERMITTENT FEVERS. 



A. Intermittent fevers are those forms of Malarial Fevers 
that have their onset and declining stage near the same time 
of day at each successive recurrence. Intermittent Fevers 
may be subdivided as follows : 

(a) Quartan. 

(b) Tertian. 

(c) Quotidian. 

QUARTAN INTERMITTENT FEVE 

a. Quartan Intermittent Fever is that form of intermittent 
fever that has its onset, exacerbation and sweating stage near 
the same time of day on every successive recurrence. Such 
a successive recurrence takes place every seventy-two hours. 
This form usually rapidly merges into a chronic form, con- 
tinuing for years unless aborted with proper remedies. 

Symptoms. The patient is seized with a slight chill, 
rigor or cold stage, the onset usually being between I P. M. 
and 6 P. M. The onset is soon followed by the exacerbation. 
During this stage the temperature rapidly rises from 102 to 
103 or 104, and the pulse becomes accelerated from 100 to 120. 
Then the sweating stage supervenes, which continues until the 
temperature and pulse rate fall to normal. After the crisis 
there is an intermission of seventy-two hours from the onset, 
when there is a recurrence of stages similar to those just de- 
scribed. Such a manifestation of symptoms recurs at or near 
the same successive periods for months, or often for years, 
unless aborted. The patient may feel well not only during 
the intermission, but also during the fever. He generally has 
a voracious appetite, and often continues his work during all 
the stages of the attack. 

Pathological condition. The liver and spleen are usually 

(20) 



Intermittent Fevers. 21 

enormously distended. In fact, children often have such dis- 
tended abdomens that they resemble toads rather than humans. 
These patients, who have been suffering for many months 
from quartan intermittent fevers, become very anaemic indeed. 

Prognosis. The prognosis as to their complete cure is 
always good. In fact, I have never seen a case but that 
promptly yielded to treatment. 

Treatment. In every case treated it is necessary to first 
direct the administration of a purgative in some form, as Xo. 
i as directed for two days. Then some sufficient cathartic 
occasionally in order to move the bowels only once daily, such 
as No. 55 or 5. As the liver and spleen are always more or 
less enlarged, a tonic should always be given during the inter- 
missions to decrease the size of the liver and spleen. In order 
to insure a complete decreased size of the liver and spleen to 
its normal size, as a liver and spleen tonic Xo. 29 should be 
given four times daily for six weeks. As there is generally an 
indigestion from lessened secretion of pepsin and muriatic acid 
in the stomach, it is necessary to aid the stomach in digestion. 
Therefore, No. 17 or 18 may be given before meals for six 
weeks. And, in addition to the treatment described, quinine 
in some form should be begun as soon as the end of the crisis 
has been reached. No. 30 or 33 may be begun, and con- 
tinued every two hours until six doses have been given. 
The quinine should be given in this way for six consecutive 
days after the last attack. Then the quinine should be re- 
duced to one dose three or four times daily for another week, 
when the quinine may be again reduced to one dose per day. 
But it is better to administer four doses daily on the seventh, 
fourteenth, twenty-first and twenty-eighth days. This form of 
treatment will cure every case of quartan fever, which is 
common in the Southern States. (Children should be given 
proportionate doses.) 

Clinical case No. 1. Mr. H. W. had a little boy, four 
years old, who had been having quartant intermittents at in- 
tervals for eighteen months. He was sallow and very anae- 
mic. Though he was greatly emaciated, his stomach and 
bowels were greatly distended, and his liver and spleen enor- 



22 Typhoid and Other Fevers. 

mously enlarged. In fact, he had the resemblance of a toad 
rather than a human. He was placed upon a strict fluid diet 
for a week, and was allowed during that time only water that 
had been boiled. And I ordered that he be given medicines 
as follows : No. I was ordered for two consecutive days. 
He was given No. 29 in fifteen-drop doses as directed. And 
I further ordered that he be given teaspoonful doses of No. 
56 every two Lours for six doses, as soon as fever had gone 
down. This daily amount of quinine was given for six days 
after his last attack, which was only the second. Then only 
four doses per day were given for another week. And he 
was given four doses per day on the seventh, fourteenth, 
twenty-first and twenty-eighth days. After six days from his 
last attack, excepting those days mentioned, he was given only 
two doses daily for thirty days. Within six weeks he was in 
good health. 



CHAPTER III, 



TERTIAN MALARIAL FEVER. 



b. Tertian malarial fever has its paroxysm, exacerbation 
and sweating stage near the same time of day every forty- 
eight hours. And such a successive recurrence every fortv- 
eight hours might continue indefinitely if not aborted by 
proper remedies. Tertian Intermittent may be subdivided 
into two types : 

(X) Benign Tertian Intermittent. 

(Y) Severe Tertian Intermittent. 

X. BENIGN TERTIAN INTERMITTENT. 

Symptoms. The paroxysm is ushered in with a chill or 
rigor usually between 8 A. M. and n A. M. The onset is 
rapidly followed by the exacerbation. During this stage the 
temperature may rise to 104 or 105, and pulse from 100 to 
120. Soon the sweating stage begins, when the temperature 
and pulse rate rapidly fajl to normal. Every forty-eight 
hours there is a recurrence of the onset, exacerbation and 
sweating stage. The expression of the face in this type is 
usually good. 

Pathological condition. In this type the liver and spleen 
are slightly enlarged, and the stomach is usually more or less 
deranged. 

Treatment. In this form No. 1 may be given for two or 
three days in succession; then Xo. 5 or 55 may be given in 
sufficient amount to move the bowels once or twice daily for 
about a week. Xo. 17 or 18 should be given before meals, 
and Xo. 29 four times daily, both of which being given for 
thirty days after last attack. Just as soon as the normal tem- 
perature is reached quinine in some form should be given 
every two hours until six doses are given. On the following 
day begin the quinine near the same time of day as begun the 

(23) 



24 Typhoid and Other Fevers. 



previous day. And this amount of quinine should be given 
in this way for four or five consecutive days after the last 
paroxysm. Then the quinine may be reduced one dose per 
day until only three doses two hours apart are given. Three 
doses a day should be continued for three days longer, when 
the quinine may be reduced down to only one dose per day, 
which should be continued for twenty-eight days after the 
last paroxysm. It is better to give three or four doses per 
day on the seventh, fourteenth, twenty-first and twenty-eighth 
days after the last attack. In this way the benignant type 
of Malarial Fever in every case thus treated may be com- 
pletely cured. 

Y. SEVERE TERTIAN INTERMITTENT. 

The onset, exacerbation and decline of this variety and 
its recurrence every forty-eight hours is similar to the benign, 
tertian type. 

Symptoms. The onset is usherc in with a distinct chill, 
rigor or cold stage. The paroxysm is rapidly followed by the 
exacerbation. During this stage the temperature may rise 
from 105I/2 to 106, and the pulse to 120 or 130. The exacer- 
bation is soon followed by the declining stage which is usu- 
ally attended by profuse sweating, but in the declining stage the 
temperature and pulse rate may fall to the normal without any 
sweating. The patient may have a voracious appetite during 
the intermissions, but usually the patient has only slight if 
any desire for food. He rapidly becomes pale, anaemic, and 
bloated or emaciated ; and his skin becomes jaundiced in color. 
In about 50 per cent, of these cases albumin may be found 
in the urine. 

Prognosis. The prognosis is always good, but in many 
cases the physician must ever be on the alert to avert sequela. 
And in doing this close attention must always be paid to the 
bowels, kidneys, stomach and skin. If these organs are looked 
after properly, and appropriate remedies given, not only 
will the physician prevent any complications or sequela, but 
he will within two weeks in every case abort the severe ter- 
tian intermittent fever. 



Severe Tertian Intermittent. 



Treatment. As soon as the physician sees that he is deal- 
ing with this type of intermittent fever, he should make an 
examination of the urine every day for albumin. And so long 
as albumin is not found in the urine the following directions 
may be given in the management and treatment of the pa- 
tient: He should be instructed to take a warm, soda, fric- 
tion bath every day, and should live strictly on a fluid diet 
for a week. And all of his drinking water should be boiled. 
In addition to this, lime water should -be placed in his milk and 
water. As his stomach is usually more or less deranged, in 
addition to the lime water placed in his boiled drinking water, 
about one or two grains of pulverized charcoal tablets may be 
also added. 

In order to relieve the abnormal blood pressure as rap- 
idly as possible, No. 13 may be given every two hours for 
twenty-four hours, then in half doses for the same length of 
time. Also No. 3 may be given for two days : then give No. 
55 or 5 in sufficient amount to cause an action on the bowels 
once or twice daily. In order to decrease the size of the liver 
and spleen, and in order to act as an anti-malarial, No. 29 
should be given daily for six or eight weeks. And. in order 
to aid digestion, No. 17 or 18 should be administered before 
meals, in plenty of water, for six or eight weeks. Thenmii- 
nine in some form should be* given. Nos. 30, 33, 34 53*135 
may be given as temperature reaches normal. The dose 
should be given every two hours until six doses are given. 
This way of giving quinine should be continued for six consec- 
utive days after the last paroxysm. Then the quinine should 
be reduced one dose daily until three doses are given. Three 
doses should then be given for three consecutive days longer. 
when only one dose may be given daily till the twenty-eighth 
day. It is necessary to give three or four doses of quinine 
every three or four hours on the seventh, fourteenth, twenty- 
first and twenty-eighth days after the last paroxysm. 

But quinine should be very cautiously given, indeed, in 
those cases of severe tertian intermittents. in which albumin 
is found in the urine ; for clinical experience has demonstrated 
that quinine often acts as a direct irritant, in many cases, to the 



26 Typhoid and Other Fez 



>crs. 



kidneys. Therefore, when albumin is present in this form 
of intermittent fever, quinine only in the form of No. 34 or 
35 should be given; and at the same time No. 31 or 32 
should be given with every dose of quinine. And, in order to 
relieve the congestion of the kidneys, tincture of veratrum 
with diuretics should be given. Veratrum may be admin- 
istered in the form of No. 54. 

Clinical case No. 2. In 1895, Miss M. H. was seized with 
a distinct chill at 9 A. M. The chill was soon followed by 
the exacerbation. At this time I saw her and found her 
temperature 105 V 2 , and pulse 130. She was given No. 1 every 
two hours as directed ; and this was repeated on the following 
day. No. 29 was given every four hours during the inter- 
mission. And quinine in the form of No. 30 was ordered to 
be begun as soon as the fever had subsided. No. 30 was 
given every two hours until six doses were given. The qui- 
nine was begun again at the same hour on the following day, 
and continued until six doses were again administered. And 
No. 31 was given with every dose of the quinine. This line 
of treatment was ordered to be given for a week, except that 
after the second day No. 1 was to be discontinued and No. 55 
substituted. However, at the end of a week, I learned that 
she had the intermittent fever regularly every forty-eight hours 
and in the same severity. During the time, I had been treating 
a large number with the same type of tertian intermittents, 
and to my intense surprise and chagrin I learned that in every 
case these intermittents had regularly returned with the same 
severity. I realized that there must be a sequela or complica- 
tion not so often met with in this type of intermittents, for I 
had not failed to abort a single case before this time for five 
years. On close examination of all these patients I ascertained 
that every case examined was suffering with acute dyspepsia, 
and had deficient secretion of hydrochloric acid and pepsin. 
Realizing that the quinine probably was not dissolved by the 
gastric juice of the stomach, No. 33 was substituted for No. 
30. Within six days every patient had failed to have their 
attacks. I might here add that No. 18 was also given. 

Clinical case No. 3. Mr. D. E. had been having severe 



Severe Tertian Intermittent. 27 

Tertian Intermittent Fever for some time, though I had per- 
sistently given him No. 1 for three days, No. 29 for three 
weeks, together with No. 18 before meals; and quinine in the 
form of 30 and 33 had been regularly given as in case No. 2, 
but his attacks would return. On examination of the urine I 
found his urine loaded with albumin. By critical experience 
I have learned that quinine is positively injurious to all pa- 
tients that have albuminuria. Therefore, I placed the patient 
on the following treatment: No. 54 every three hours, No. 55 
in teaspoonful doses every four hours, No. 18 before meals, 
and tincture of iron in six to ten-drop doses was added four 
times daily. An enema of one quart of .64 per cent, of chlo- 
ride of soda solution was used as an enema once a day. And 
No. 3 was given every three hours as directed ; and as soon 
as normal temperature was reached he was given quinine every 
two hours. The patient never had but one more paroxysm. 
And within four weeks, all of the albumin had disappeared 
from the urine. No. 34 was discontinued after four weeks 
after last attack. After thirty days only No. 54 in one-third 
size doses, No. 18 before meals and Steam's Wine of Cod Liver 
Oil were continued for thirty days longer. Then the patient 
was dismissed, he being in robust health. 



CHAPTER IV. 

C. INTERMITTENT QUOTIDIAN FEVER. 

In this form of intermittent fever the paroxysm usually 
occurs near the same time of day, and the third stage usually 
subsides near the same hour every day, there being a daily 
recurrence of the three stages. The quotidian intermittent 
fevers may be divided into three distinct types : 

(X) Benign Quotidian Intermittent. 

(Y) Severe Quotidian Intermittent. 

(Z) Congestive Quotidian Intermittent. 

X. BENIGN QUOTIDIAN INTERMITTENT. 

Symptoms. The patient is usually seized with a distinct 
chill or rigor between 8 A. M. and n A. M., which chill is 
soon followed by the exacerbation. During this stage the tem- 
perature suddenly rises to 103 or 104 and pulse to no to 
120. The exacerbation is soon followed by the third or de- 
clining stage. During this stage there is profuse sweating, 
which soon lowers the temperature and pulse rate to normal. 

All the symptoms as described of the onset, exacerbation 
and decline recur every twenty-four hours. During the in- 
termissions the patient may seem apparently well, and he 
often has a voracious appetite. 

Treatment. Give No. 1 for three days in succession. 
After the purgatives have been given for three days, then No. 
5 or 55 may be given daily in sufficient amount for six or 
eight days after the last attack to cause the bowels to act once 
or twice daily. No. 18 before meals and 29 four times daily 
should be given for thirty days after last attack of the inter- 
mittent fever. And quinine in some form in five-grain doses 
should be begun as soon as normal temperature is reached. 
If this form should resist being aborted, then give quinine only 
in soluble form. 

(28) 



Benign Quotidian Intermittent. 29 

Clinical case No. 4. Mr. F. X. had been having mild 
intermittent quotidian fever for some weeks, when I saw him 
during the exacerbation period. His temperature was 104 
and pulse 116. I ordered Xo. 1 to be given every two hours 
for four doses as directed, which was to be repeated for three 
days. Xo. 18 was ordered to be given before meals for thirty 
days, and Xo. 29 was to be given four times daily for the 
same period. Xo. 30 was ordered to be given. But the pa- 
tient returned after ten days, saying that he was chilling as 
before. Xo. 33 was substituted for Xo. 30. As a result of 
this change, he never had another chill. 

Y. SEVERE QUOTIDIAN INTERMITTENT. 

In this type the chill or rigor occurs near the same time 
of day as the benign form, but the temperature is much higher, 
being from 104I/0 to 105 1 /: or 106, and the pulse from 120 to 
132. The facial expression is usually not good, and the pa- 
tient rapidly becomes pale and anaemic. The declining stage 
causes the temperature and pulse rate to fall near the same 
time of day by sweating. The symptoms of onset, paroxysm 
and decline recur every twenty-four hours. 

Treatment. In this type, in order to abort the disease as 
soon as possible, and thus prevent albumin in the urine, 
prompt and heroic measures should always be used from the 
very beginning of treatment. No. 3 may be given for two 
consecutive days, when Xo. 1 may be substituted instead of 
No. 3 for two or three days longer; and then, if the patient 
has any recurrence of these severe forms of intermittents, 
No. 5 or 55 may be given in sufficient amount to move the 
bowels once or twice daily. Nos. 29 and 18 may be given for 
six or eight weeks after the last attack. During the fever 
X T o. 54 may be given in full doses every two hours ; and this 
medicine may be given in one-third size doses every four 
hours during the intermission. In the very beginning quinine 
in the form of No. 30 may be given every two hours till six 
doses are given, which should be continued near the same time 
of day for five consecutive days after the last attack. Then 



30 Typhoid and Other Fevers, 

the quinine should be dropped one dose per day until three 
doses are reached, when this number of doses should be con- 
tinued for four or five days longer. After this time only one 
dose a day should be given until thirty days after last attack. 
However, three or four doses daily should be administered 
on the seventh, fourteenth, twenty-first and twenty-eighth days 
after the last attack. But if No. 30 has failed to abort the 
attack within five or six days after the beginning of treat- 
ment, then quinine in soluble form should be ordered to be 
given as already described in tertian fever. But if No. 33 
does not abort the intermittent, then carefully examine for 
albumin. And if albumin is present, treat the case as in the 
severe tertian type already described. 

Clinical case No. 5. Mrs. N. H. had been having severe 
quotidian fever for a week, when I found her temperature 
106 and pulse 134. She was given No. 3 every two hours 
until four doses were given, followed by salts. No. 15 was 
given every four hours, and No. 18 was ordered before meals. 
As soon as her temperature fell to normal, she was given No. 
29 four times daily, and No. 33 was given for six days. But 
since the paroxysm returned her urine was examined. How- 
ever, no albumin was found. She was given No. 54 instead 
of 15 ; No. 34 immediately after the beginning of the paroxysm 
was given, and No. 35 every four hours between the inter- 
mission were substituted for No. 33. As a result, within a 
week the attacks subsided. She was then given for thirty 
days Nos. 18, 35, 29, and eight-drop doses of tincture of iron; 
and she was given daily a warm friction soda bath. After 
thirty days she was then placed on Elixir of Beef, Iron and 
Wine, with Steam's Wine of Cod Liver Oil. She made a 
complete recovery. 

Clinical case A T o. 6. Mr. C. H. had been having severe 
quotidian intermittent fever for a week, when I was called in 
to see him during the exacerbation of the fever. The onset 
was ushered in with a severe rigor, which continued until 11 
A. M., when the exacerbation stage set in. Soon the tem- 
perature arose to 105 and pulse to 120. He was given No. 3 
every two hours until four doses were taken, and followed two 



Severe Quotidian Intermittent. 31 

hours after last dose by salts. Nos. 18 and 29 were ordered to 
be given three and four times daily respectively, and quinine 
in the form of 33 was given every two hours as soon as the 
temperature had fallen to normal. But forty-eight hours 
later I was again called in to see him. I ascertained that his 
temperature had fallen to normal. The onset was ushered in 
with a prolonged rigor, continuing for five hours. His temper- 
ature rose to 1063-5 and pulse to 140. He was given Xo. 1 
every one and one-half hours until four doses were given, and 
followed one and one-half hours after last dose by one table- 
spoonful of sulphate of magnesia in three ounces of water. 
No. 13 was given him every fifteen minutes until four doses 
were given; then every thirty minutes for two doses; after 
this No. 13 was given every two hours until temperature fell 
to normal. On examination of the urine, albumin was found. 
As soon as the temperature fell to normal, he was given the 
following: Nos. 18 and 29 were given as in previous cases; 
No. 13 was given during the intermission in one-third size doses 
every three or four hours; and Nos. 34 and 35 were given as 
in case No. 5. Also tincture of iron was added in seven-drop 
doses to No. 29. Within another week the fever was aborted. 
And after two weeks only No. 35, in teaspoonful doses, with 
Nos. 29 and 18 were given for thirty days after the last parox- 
ysm. Then for two more w,eeks Beef, Iron and Wine, with 
Steam's Wine of Cod Liver Oil, were given, only Nos. 29 
and 18 being continued in half doses. 

Z. ACUTE CONJECTIVE QUOTIDIAN INTERMITTENT. 

In this type the onset is usually ushered in with a cold or 
hot stage; but occasionally there may be a more or less dis- 
tinct rigor. The onset of this type usually occurs between 4 
P. M. and 8 P. M. There is usually a more or less sudden 
rise of the temperature and increased acceleration of the pulse. 
Soon the temperature and pulse rate begin to fall. The fall 
of the temperature is usually without any sweating, which, 
however, in some instances may be very profuse. The tem- 
perature in this form has a great tendency to drop greatly 



32 Typhoid and Other Fevers. 

below the normal, causing at the same time intense prostra- 
tion. Another predominant characteristic of this form of 
quotidian intermittents is the fact that usually the bowels are 
moved only with the greatest difficulty ; and another important 
feature is the strong contraindications of any form of quinine 
in the majority of these cases. 

Prognosis. The prognosis is always good, if close atten- 
tion be paid to the dietetic and therapeutic management of 
the patient. 

Treatment. As soon as a. case of this kind is seen, the 
family should be informed that they must carry out your every 
order if they desire the patient to rapidly recover. In the 
first place, No. 13 or 54 should be given every hour or two 
in proportional doses according to age. No. 55 may be given 
in full doses during the fever, in order to slowly move the 
bowels and prevent absorption of poison. But if No. 13 or 
54 has been given for two or three days with recurrences of 
the intermittent fever, these medicines should be abandoned. 
Then No. 16 in appropriate doses should be carefully given. 
In all of these cases small doses of sulphate of magnesia in 
frequent doses should be carefully given, for salts in minute 
doses seems to do more good in these cases than any other 
medicine. If the temperature falls far below normal, as, for 
instance, as low as 94 or 95, under the axilla or in the mouth, 
stimulants of some kind should be cautiously given. If there 
is profuse sweating at the time,atropia sulphate 1-150 gr. should 
be given every four hours ; but if the skin is dry and harsh, and 
if the secretions are already scanty, atropia in any form should 
be given very sparingly if given at all. In such cases strych- 
nia sulphate in 1-30 to 1-60 grain doses may be given every 
four hours; but if there is much difference between axillary 
temperature and that of the mouth, or if pulse is very rapid, 
or, a zigzag temperature and pulse rate, strychnine should be 
given with the greatest caution. Fowler's Solution with 
Sweet Spirits of Nitre is always given with safety in this 
disease. Let it always be borne in mind in this disease, as in 
other diseases, that aconite, gelsemium, digitalis and verat- 
rum are indicated only when they lessen bodily temperature 



Acute Congestive Quotidian Intermittent. 33 

and pulse rate, keeping them (temperature and pulse ) at all 
times near a certain proportional ratio with each other ; and let 
it be distinctly remembered, when the reverse is the case, that 
they (such remedies) are contraindicated. And let it be fur- 
ther remembered that though it is always necessary to give 
stimulants with the utmost discretion in all diseases with sub- 
normal temperature, yet in this disease extreme precaution 
should always be used in giving stimulating remedies during 
the intermission for fear of causing a recurrence, or for fear 
of causing an increased severity of the disease. Usually no 
stimulation is necessary unless temperature falls below 96. In 
rare cases a little stimulation may be given in such cases where 
the patient has his head thrown back, as if in a dying condition. 
Then, even if temperature is above 96, the patient should be 
stimulated. But, as a rule, if a patient with a temperature 
below 96 is quietly sleeping, he does not need any stimulation. 
If there is any doubt as to whether or not to give stimulating 
medicine, then give a little opium in the form of dover pow- 
ders every four hours in two or three-grain doses, and the 
patient will most likely miss his intermittent fever. In many 
cases the patient seems to become very nervous, which ner- 
vousness often causes a return of the fever. In such cases 
dover powder, or bromide of soda, with one-drop doses of flu. 
ext. of gelsemium, may be given. In these cases, where the 
bowels are moved with so great difficulty, small enemas — one- 
half to one pint — of a .64 per cent, solution of chloride of 
soda often is very efficient. I have recently seen that, usually, 
no remedy in such cases acts so well as castor oil. The foun- 
tain syringe in such cases should not be elevated more than 
two or three feet above the patient. And bathing these pa- 
tients in warm soda water solutions by friction often does 
much good. 

Clinical case No. 7. A little girl, six years old, had 

been sick for a week when I first saw her, in September, 19 . 

The temperature in axilla was 98, and under the tongue was 
99 2-5, and her pulse was 112, and her prostration seemed very 
great. Though the father considered her in grave danger, 
yet I assured him the prostration could be controlled. We 



34 Typhoid and Other Fevers. 

placed her under No. I elix. lactated pepsin in twenty-drop 
doses before meals, and No. u in one-third size doses. This 
treatment was continued about seventy-two hours, and gel- 
senium and potassium were given. Bromides were given 
in appropriate doses. On every consecutive evening her tem- 
perature would rise from 102 to 104, and pulse from 120 
to 132. Within two or three hours after every consecutive 
recurrence of the hot stage, the temperature would de- 
cline with a slight sweating on forehead and face. But 
the father would become alarmed as soon as her temper- 
ature dropped to normal, and he would administer other 
medicines, which, by lessening secretion, probably caused 
repeated recurrence of the fever. In order to avoid any in- 
terference with medicines given, I remained at her bedside 
for one night. As soon as her temperature fell to normal she 
was continued on pepsin in one-third teaspoonful doses, with 
one drop of Fowler's Solution and ten-drop doses of listerine 
every three hours. Though her temperature and pulse slowly 
dropped, I did not permit any form of stimulation until her 
temperature by the mouth had fallen to 97, and pulse to 72; 
at the same time the feet had become cool and clammy, and 
her pulse would occasionally intermit. Now had come the 
time for slight stimulation ; therefore I gave her 1-600 grain 
of sulphate atropia with 1-180 grain of strychnine every three 
hours. And, by giving dover powders in one-grain doses to 
quiet the nervous system, she made a rapid recovery. 



CHAPTER V. 

MALARIAL HAEMATURIA OR HAEMOGLOBINURIA. 

History. The patient having - hematuria or haemoglobi- 
nuria will usually give the following history: He has been 
suffering from that severe form of intermittent fever in 
which albumin is present. Haemoglubinaria will finally result 
in this form of intermittent fever in 25 per cent, of all the 
cases having present albumin. For this reason it is necessary 
to treat hematuria, hemoglobinuria or black-water fever at 
this place as a sequela from severe types of tertian and quo- 
tidian malarial fever. 

Clinical pathology. As a result of the faulty action of the 
Vaso-motor Systems, an abnormal amount of blood has col- 
lected in the spleen and liver. But the predominant charac- 
teristic condition is the abnormal collection of blood and in- 
flammatory products in the region of the kidneys. 

Clinical etiology. Broadly speaking, the deeper, under- 
lying cause is the faulty action of the vaso-motor system, thus 
causing an increased abnormal amount of blood and other in- 
flammatory products to collect in the internal organs, mainly, 
however, in the region of the kidneys. 

Symptoms. The patient is seized with a distinct chill or 
rigor, which is usually of marked severity and long duration. 
The chill is rapidly followed by asthmatic and stertorous 
breathing, which are due to the severe infection of the kid- 
neys. Such a condition somewhat simulates pneumonia : in 
fact, many physicians have mistaken such a condition for pneu- 
monia. But any close observer who has seen puerperal con- 
vulsions will often see similar symptoms in those suffering 
with hemoglobinuria. The temperature may not rise higher 
than 101 and pulse, 80 or 90 even in the severest cases. And 
there is more or less blood found in the urine ; in severe cases 
the urine is nothing more than black, clotted blood. The pa- 
tient soon becomes intensely jaundiced. 

(35) 



36 Typhoid and Other Fevers. 

Preventive treatment. Malarial hematuria, or hsemoglo- 
binuria, may always be prevented by timely and judicious 
treatment. It is true that Nothnagel treated a case of 
intermitent fever for six months and then the patient was 
finally seized with a fatal attack of malarial hemoglobin- 
uria. But such a fatality resulted, no doubt, solely from 
the erroneous idea that some forms of intermittents can- 
not be aborted. The very fact that Nothnagel, Osier and 
many other eminent observers designate as malignant types 
those types of intermittents that rise no higher than 105 and 
pulse 120 plainly indicates that such observers have seen most 
of their cases in higher altitudes than where most of the very 
malignant types are found. 

Prognosis. If great attention is paid to every case treated, 
then the mortality of even the severest types of these cases 
will not be more than 5 per cent. ; and even in most of these 
fatal cases the physician will not have been called in probably 
until irreparable damages have already taken place in the 
kidneys. 

Treatment. In order to remove the engorgement of the 
kidneys and lower blood pressure as rapidly as possible, No. 13 
may be given every fifteen minutes until four or five doses 
have been given; then it may be given every thirty minutes 
for two doses, after which one dose every hour for three doses 
should be given in the most desperate cases. And in order to 
further protect the kidneys, No. 5 may be given every three 
hours in tablespoon doses until free action of the bowels has 
taken place; at the same time half a gallon of a warm .9 per 
cent, solution of chloride of soda should be given as an enema 
every four hours, and also the diuretic, No. 57. A warm fric- 
tion bath of soda and warm water should be given every two 
or three hours. No quinine should ever be given in any form, 
for it does more harm in these cases than good. 

Clinical case No. 8. In 1902 Mrs. Jane W., who had 
been having the severe tertian intermittents for several 
months, was seized at 1 P. M. with a severe rigor, which con- 
tinued till 4 P. M. At that time she passed her urine, which 
was about fifty ounces, and the urine contained nothing but 



Malarial Haematurea or Hacmacjlobiniiria. 37 

black, clotted blood. I saw her for the first time at 5 P. M.; 
her temperature was 106, and her pulse 148. I learned that 
she had passed some deep, red, bloody urine the previous day. 
She had a deep stertorous breathing ; also asthmatic sounds in 
both lungs could be distinctly heard at a distance of four feet 
away. She was given three quarts of a warm ,9 per cent, of 
chloride of soda solution as an enema, the fountain syringe be- 
ing held three and one-half feet above the patient ; and the ene- 
ma was repeated every three hours. At the same time she was 
given one sixth grain of calomel with No. 13 every fifteen min- 
utes until six doses were given, after which Xo. 13 was given 
every half hour, and then every hour for three doses. Xo. 
13 was then given every two hours throughout the next 
twenty-four hours. In addition to this heroic treatment. No. 5 
was given every three hours, Xo. 18 before meals, and Xo. 57. 
At 9 P. M. her urine had become dark red in color, at 1.30 
A. M. the urine was light red, and at 8 A. M. it had become 
yellowish. And by 8 P. M. there was no blood casts found in 
the urine; but there was some albumin found for thirty days. 
She was on her feet again within ninety-six hours. I then 
placed her on Nos. 9 and 18 for a month. She took broken 
doses of No. 55. After thirty days she was placed on Beef, 
Iron and Wine and Steam's Wine of Cod Liver Oil. 



CHAPTER VI. 

INTERMITTENT MALARIAL ANTICIPATING. 

In this form of Malarial Intermittent the onset recurs 
earlier and the intermission later on every consecutive recur- 
rence. 

There are two forms of intermittent malarial anticipating: 

(a) Quotidian Intermittent Malarial Anticipating. 

(b) Tertian Intermittent Malarial Anticipating. 

a. The quotidian intermittent malarial anticipating fever 
always has a consecutive recurrence of its onset in less time 
than twenty-four hours, while the recurrence of the intermis- 
sion is always more than twenty- four hours. 

And the tertian intermittent malarial anticipating always 
has a consecutive recurrence of its onset in less time than forty- 
eight hours, while the recurrence of the intermission is always 
more than forty-eight hours. 

Differential diagnosis between distinct malarial intermit- 
tents and malarial anticipating intermittent^, (i*) A malarial 
intermittent has its onset and intermittency near the same time 
of day, but in malarial intermittent anticipating the onset re- 
curs earlier and the intermittence recurs later with every re- 
currence. (2) In the intermittents the third stage declines by 
sweating and crisis, but in the anticipating form the third 
stage usually declines with lysis without sweating, and fur- 
thermore all of the intermissive forms are milder in character 
than the anticipating forms. 

But since both forms may be subdivided and treated clini- 
cally in the same way, it is only necessary to subdivide one 
form of the malarial intermittent participating variety. 



* In referring to both forms, intermittent and anticipating, it is supposed that 
quinine has not been given ; for quinine will lengthen the duration of the inter- 
mission in both forms. 

(38) 



Intermittent Malarial Anticipating. 39 

Malarial intermittent participating fever may be subdi- 
vided into two types of intermittent anticipating fevers : 

(a) Benign Malarial Intermittent Anticipating. 

(b) Malignant Intermittent Anticipating. 

(a) BENIGN MALARIAL INTERMITTENT ANTICIPATING FEVER. 

This type of intermittent usually has its onset between 8 
A. M. and 11 A. M., but the onset may^ occur at any hour of 
the day. 

Symptoms. The onset is ushered in with a chill, rigor or 
cold stage. Soon the exacerbation supervenes. During this 
stage the temperature may rise to 104 or 105 and the pulse to 
120. The declining stage is usually without sweating and 
falls by lysis. And every successive paroxysm recurs at an 
earlier hour, and every successive intermission recurs at a 
later hour every day — or every other day, as the case may be — 
than the previous attack. If not controlled by anti-malarial 
remedies, this type will gradually merge into remittent fever. 

Prognosis. This type of intermittent anticipating malarial 
fevers may be aborted in every case when treated properly. 

Treatment. Begin with No. 1 or 3, as directed, for three 
or four successive days. Order No. 18 to be administered be- 
fore meals for one week after the abatement of the fever. If 
any purgative is needed after four^or five days, then give No. 
5 or 55 in sufficient amount to move the bowels once or twice 
daily so long as there is any fever. As a slight antipyretic, and 
as a diuretic, No. 1 1 may be given every three or four hours, 
with three-grain doses of salol during the pyrexia.. Then 
quinine in some form should always be given only during the 
intermissions, and if the intermission is very short in dura- 
tion, quinine in five-grain doses should be given every thirty 
minutes until six doses have been given, unless a recurrence 
of the onset, when quinine should be omitted. If only an hour 
or two of the intermission, it is better to give in addition to 
the quinine No. 34. And, furthermore, No. 29 should always 
be given every three hours when there is an intermission of 
at least twelve hours. But when there is an intermission of 
only a few hours, No. 12 may be substituted for No. 11 and 



4-0 ' Typhoid and Other Fevers. 

given every four hours. In all the anticipating types it is 
usually better to give the quinine in solution. 

In benign anticipating malarial fever it is very easily seen 
whether or not the fever is being successfully managed, for if 
the fever is being aborted the intermittent period is growing 
longer and the severity of the symptoms is growing less on 
every recurrence. On the other hand, if the intermissions are 
growing less, and the severity of every successive attack is 
growing more severe, then it is absolutely necessary to give 
quinine and purgatives more rapidly. Daily bathing and 
enemas seem to aid in aborting this type very materially. 

Clinical case No. 9. Mr. B. K. was seized with a slight 
rigor, which was soon followed by rapid rise in temperature, 
the temperature being 103 and pulse 112. The second stage 
continued for four hours, when the third stage begun; the 
temperature slowly declined to normal without sweating. 
Nos. 1, 18 and 11 were given as directed, but at 4 A. M., three 
hours earlier than previous day, the patient was again seized 
with a rigor. And soon the hot stage set in ; during this stage 
the temperature rose to 104 3-5 and pulse 120. The third 
stage begun at 5 P. M., two hours later than previous day ; the 
normal temperature was not reached until at 11 P. M. Real- 
izing that the intermittent anticipating fever was rapidly 
merging into remittent fever, I gave the following: No. 3 
was given every one and one-half hours until four doses were 
given; also calomel in one-sixth grain doses was given every 
fifteen minutes until six doses were given. No. 33 was given 
every thirty minutes until six doses were given, and No. 34 
was given in two doses as directed. At the same time No. 12, 
with three-grain doses of salol, were given every three hours. 
The onset did not recur until 8 o'clock the following morning. 
The temperature rose to 103 and pulse to 115. The tempera- 
ture had fallen to normal by 4 P. M. Then the same treatment 
of previous day was carried out. As a result of this heroic 
treatment the fever was aborted. He was then given No. 55 in 
doses just sufficient to move the bowels once a day. Nos. 12 
and 18 were continued in one-half size doses, and No. 35 was 
given in one teaspoonful doses for ten days. He was soon 
perfectly restored to health. 



Malignant Intermittent Anticipating Malarial Fever. 41 

y. Malignant Intermittent Anticipating. Malignant an- 
ticipating malarial fever may be subdivided into the following 
distinct grades : 

(x) G astro-enteric Variety. 

(y) Algid Variety. 

(z) Comatose Variety 

X. GASTRO-EXTERIC VARIETY. 

Symptoms. The patient is seized with a distinct chill, 
rigor, or hot stage, which is rapidly followed by the exacer- 
bation. The patient usually complains of intense pains in the 
region of the stomach ; and at the same time he is often seized 
with frequent attacks of vomiting. The temperature may rise 
to 107 or 108 and the pulse from 140 to 165 in an adult, or 
from 220 to 280 in an infant. And the third stage declines 
with little or no sweating by lysis. If no treatment is given 
the recurrence of the attack will become more severe with 
every successive recurrence. 

Prognosis. The prognosis is good, if prompt remedial 
measures are heroically given. 

Treatment. Though the stomach is very irritable, how- 
ever, it is absolutely necessary that the patient must be given 
to understand that his life depends upon rigidly carrying out 
the directions. And so I have never had any trouble in get- 
ting the patient to retain the medicine given him. Have the 
patient to drink but little water. In order to prevent thirst, 
enemas of about 8 oz. of .9 per cent, of chloride of soda 
solution may be given every four to six hours. If the stomach 
should be irritable, give No. 25, 2j f 45, or cerium oxalate in 
five-grain doses. In many cases a mustard plaster over the 
epigastric region quiets the stomach. Pulverized charcoal or 
burnt bread crust has quieted the stomach when everything 
else have failed. In rare cases the stomach may be too irrita- 
ble to retain medicine, or he may be unconscious ; then give 
hypodermic injections of morphia sulphate one-quarter grain 
to quiet the stomach. 

After the stomach has become quieted, No. 3 may be 
given every one and a half hours until five doses have been 



42 Typhoid and Other Fevers. 

given. One and a half hours after the last dose, salts, castor 
oil, or some other cathartic may be given. At the same time 
one-sixth grain of calomel may be given every fifteen min- 
utes until six or eight doses have been given. No. n may be 
given every three hours during the fever. During the inter- 
mission No. 12 may be substituted. And, also, No. 18 may 
be administered before meals. The patient should be given 
a warm friction soda bath every hour or two during the fever. 
As soon as temperature has reached normal, No. 30 may be 
given every half hour until six doses have been given, and No. 
35 every three hours in two teaspoonful doses may be adminis- 
tered. In the large percentage of cases, if this treatment has 
been rigidly carried out, the next paroxysm is aborted or at 
least greatly lessened in severity. If the severity is greatly 
lessened, then the treatment of the former attack will abort 
the disease. But if the attack should recur with still greater 
malignancy, it is evident that large enough doses have not 
been given. So then the treatment of previous attack should 
be given, except that No. 3 be given every hour until six or 
eight doses have been given. And it is most remarkable how 
these patients bear purgatives and quinine. Bathing in tepid 
or cold soda water by friction may be used every hour in these 
cases. Hot mustard baths seem to do good in these cases. 
With such heroic treatment the temperature will after a time 
begin gradually to subside, when No. 3 every hour with two 
doses of No. 34 should be given with No. 1 every two hours. 
In this way the fever will be aborted or greatly lessened in 
intensity. Let it always be remembered that the fever in 
these severe cases is always of much more grave danger than 
heroic doses of calomel, so long as there is vomiting of bile 
or action of the bowels of not more than six or eight times 
within twenty-four hours. After the disease has been les- 
sened in intensity, these fevers may be treated similar to the 
benign anticipating form of intermittents. 

Clinical case No. 10. J. H. was seized with a violent 
rigor in September, 1896, and soon he was seized with violent 
cramping in the epigastric region, with violent emesis. Dur- 
ing the exacerbation the temperature was 107 and pulse 142. 



Gastro-cntcric Variety. 43 



He being a strong man, I gave him No. 3 every hour until six 
doses were given; at the same time one-sixth grain of calomel 
was given every fifteen minutes, which quieted the irritated 
stomach. No. 18 was given in plenty of water every four 
hours, and No. 11 was given every three hours during the 
fever. As soon as the fever had subsided he was given No. 
30 every hour till seven doses were given. And No. 1 was 
given at this time every two hours. On the following day 
the onset came later than on previous day; and during the 
exacerbation the temperature rose to only 103 and pulse to 
112. No. 3 was given every two hours until four doses were 
given, followed two hours after the last dose by one table- 
spoonful of eps.om salts. And No. 30 was given every two 
hours until six doses were given. Also Nos. 18 and 29 were 
given in the same way as in the benign form of benign inter- 
mittent participating fever. 

Clinical case No. 11. On the 8th day of September, 
1894, at 8 P. M., Mrs. J. was seized with a severe rigor of two 
or three hours' duration, and she was seized immediately with 
severe cramping, violent emesis and dysentery. During the 
exacerbation the temperature was 106V2 an( l pulse 138. I 
ordered her to take No. 45 to quiet her stomach ; and No. 1 
was ordered every one and a half hours until four doses were 
given, at the same time one-sixth of a grain of calomel was 
given every fifteen minutes until six doses were given. Nos. 
18 and 11 were ordered also to be given as directed. At the 
same time a warm friction soda bath was ordered to be given 
every three hours, and an enema of eight ounces of .9 per 
cent, of salt solution was ordered to be given every four hours. 
Though her temperature had fallen to normal, and she was 
apparently well, however, I was surprised to learn that she 
had not taken the purgative No. 1 at all. Then I ordered her 
to take No. 1 as directed. No. 30 was ordered to be given 
every two hours. But she again refused to take Nos. 1 and 
30. As a result of this neglect, on September 10th, at 4 
P. M., she ha4 a severe paroxysm. And during the parox- 
ysm she was seized with vomiting and cramping in the epi- 
gastric region. Soon the exacerbation set in. During this 



44 Typhoid and Other Fevers. 

stage the temperature rapidly rose to 108 and pulse 165. She 
became unconscious. Friction baths of cold soda water solu- 
tions were given every hour; but her temperature remained 
at 108 until 10 P. M., when temperature declined by lysis. 
At 5 on the following morning, her temperature having fallen 
to 105, she regained consciousness. Then I urged No. 3 to 
be given her every hour until six doses were given. And No. 
30 was given every hour until eight doses were administered; 
and during this time two doses of No. 34 were given. As 
soon as the eighth dose of quinine was given, an interval of 
only four hours was given, when No. 30 every hour for six 
doses was given. At the same time Nos. 1 1 and 29 were given 
every three hours. And after an interval of only four hours 
after the last dose of No. 3 was given, No. 1 every one and a 
half hours was given until four doses were administered. By 
12 M. the temperature had fallen to normal. And, as a result 
of this heroic treatment, she never had another attack, even 
in the slightest form. She was given No. 1 three times daily 
for fifty days, when her skin had become perfectly clear, and 
she had gained fifteen pounds in weight. 

Clinical case No. 12. Mrs. Ellen Mc. was seized with a 
slight rigor, November 8, 1896, at 10 A. M., which was soon 
followed by the exacerbation. During the exacerbation the 
temperature was 106 1-5 and pulse 138. She had severe at- 
tacks of cramping in the epigastric region, and had almost 
uncontrollable vomiting. She was ordered *to be given Nos. 
1, 18 and 11 as directed, and ordered to be given No. 30 every 
two hours during the intermission. But her stomach was so 
irritable that but a small amount of the medicine was re- 
tained. As a result of such an irritable stomach, the onset 
recurred again at 4.30 A. M. with increased severity. The 
rigor continued for an hour, when the exacerbation begun. 
During this stage the temperature rose to 107 1-5 and pulse 
150. She constantly complained of cramping pains in the 
epigastric region, and bilious vomiting was very severe; but 
finally the irritability of the stomach was quieted by cerium 
oxalate and pulverized charcoal. Immediately afterwards 
No. 3 was given every one and a half hours till four doses 



Gastro-cntcric Variety. 45 

were administered, and then Xo. 1 was given one-half hour 
after every dose of No. 3. At the same time Xos. 18 and ir 
were given. Friction baths and enemas of .9 per cent, salt 
solution in tepid water were given every four hours. The 
third stage fell to normal by^ 3 A. M. Immediately Xo. 30 
was given every half hour until eight doses were adminis- 
tered. At 12 M. the onset returned with a hot stage, which 
was soon followed by a temperature of 104, and the normal 
temperature was reached by 5 P. M. She was then given 
Nos. 1 and 30 every two hours, and No. 12 was given every 
three hours in one-half size doses. She did not have another 
paroxysm. The treatment carried out, then, was similar to 
other cases already described. 

Clinical case No. 13. J. T. was seized with a distinct hot 
stage, accompanied with severe vomiting and cramping in 
the epigastric region. His temperature rose to 105% and 
pulse 130. He was given Xos. 1, 18 and 11, but I was sent 
for to relieve the severe pain. A mustard plaster over the 
epigastric region soon relieved the pain and vomiting. But 
the onset returned with greater severity, for he refused to 
take quinine in any form. As a result the onset returned two 
hours earlier on the following evening. His temperature rose 
to 106 1-5 and pulse 138. And there was a recurrence of 
severe vomiting and cramping. He* begged for medicine to 
relieve the pain and vomiting, and he was given morphia one- 
quarter with five grains of bismuth every hour until relief was 
obtained. After the second dose he fell into a quiet slumber, 
from which he was not disturbed until the following morning, 
when his temperature had fallen to 102 and pulse to 120. Re- 
alizing that the fever was merging into remittent fever, I 
gave him the following: Xo. 3 every one and a half hours 
until four doses were given, and he was given Xo. 1 every two 
hours, together with one-sixth grain of alomel, every fif- 
teen minutes for six doses. Xos. 18 and 11 were given every 
three hours, and Xo. 30 every hour, while X T o. 34 was given as 
directed. The onset recurred by a slight rise of the tempera- 
ture, it rising to 103 and pulse to 112. The vomiting and 
cramping were only slight in character. By I A. M., the tern- 



46 Typhoid and Other Fevers. 

perature having fallen to 10 1, he was given Nos. 1 and 30 
every two hours, and Nos. 18 and 11 were given every four 
hours. His temperature fell to normal. by 8 A. M. without 
any sweating. The temperature rose at 4 A. M. only to 
1002-5. The treatment of the previous night was repeated, 
and then the treatment that followed was similar to that fol- 
lowed in other similar cases under the same conditions. 



CHAPTER VII. 



ALGTD TYPE. 



The algid type, called congestive chills, is most fre- 
quently of the Tertian anticipating form; but they may occur 
from the quotidian anticipating. 

Symptoms. The patient is seized with a cold stage of 
prolonged duration. During this stage the whole surface may 
become icy cold; the patient often lies as if dead, for often 
there is no perceptible pulse beat. However, the heart sounds 
may be heard distinctly with a stethoscope in that region. 
After the icy stage the temperature often reaches 107 or 108, 
and the skin becomes intensely hot. Usually there is but 
little vomiting. 

Treatment. During the icy stage the patient should be 
rubbed briskly every thirty minutes with hot mustard water, 
and hot jugs and hot bottles should be placed around the 
patient, in order to warm the patient and also cause free 
diaphoresis. If the patient is totally unconscious, hypoder- 
mic injections of five-drop doses of tincture of veratrum with 
1-200 grain of nitro-glycerine every two hours may be given, 
in order to cause an equilibrium of heat in the body to be- 
come established. And then if veratrum lowers the pulse 
rate and bodily temperature it may be continued, otherwise 
omitted. In such cases No. II, aconite and gelsemium may 
be used, if they lower bodily temperature and pulse rate. 
Enemas of warm or cold chloride of soda solutions usually 
do much good, and warm or cold friction baths may be given. 
And, in order to know whether the enema or friction baths are 
doing the good desired, it is only necessary to take the tem- 
perature and pulse rate one hour after using them. If lower 
temperature and pulse rate are shown, then they are doing 
good, otherwise not. As soon as the patient becomes con- 
scious No. 3, 11 or 13 and 18 should be given as directed. 

(47) 



48 Typhoid and Other Fevers. 



And, as soon as the temperature begins to fall, No. 33 or 30 
should be given every two hours until eight doses are given; 
and as soon as normal temperature is reached No. 34 should 
also be given. Such heroic measures will usually prevent 
another recurrence; but if a recurrence takes place the at- 
tack is much lighter in character. Then the treatment to be 
followed out is similar to that of the intermittents. 

Clinical case No. 14. Mr. W. J. E. was taken with a 
severe cold stage. The body seemed as cold as ice almost, and 
he soon became unconscious. His temperature under the 
axilla was 93, while the thermometer registered 104 per rec- 
tum. Immediately jugs and bottles containing hot water were 
placed all around the patient, and at the same time hot fric- 
tion sponge soda baths were ordered every hour. The pulse 
being imperceptible at the wrist, he was given hypodermic in- 
jections of 1-30 grain of strychnia and 1-150 grain of sulphate 
of atropia every hour. But in a few hours the reactionary 
stage began. His temperature rose to 1062-5, an d pulse be- 
came not only perceptible, but regular and strong, being 144 
per minute. And the warm friction baths were continued 
every two hours. As soon as consciousness returned he was 
given No. 3 every two hours until five doses were given, fol- 
lowed by salts; and one-sixteenth grain calomel with No. 13 
was given every thirty minutes until six doses were adminis- 
tered. He was also given Nos. 13 and 35 every four hours. 
And as soon as the temperature had fallen to 100 he was given 
No. 30 every hour until seven doses were given. He had a 
slight attack of fever again, the temperature reaching only 
103 and pulse 116. Then the treatment as given in regular in- 
termittents was daily administered. The patient soon entirely 
recovered. 

Clinical case No. 15. Mrs. C. C. was taken with a distinct 
rigor, followed by prolonged marble coldness of the whole sur- 
face of the body. During this stage the temperature under the 
axilla fell as low as 94, while the thermometer registered per 
rectum 105. The patient soon relapsed into semi-conscious- 
ness. Bottles and jugs containing hot water were placed all 
around her, and hot bricks were also placed in her-bed. After 



Algid Type. 49 



four or five hours the cold stage was replaced by the exacer- 
bation. During this stage the skin became intensely hot and 
dry, then the temperature rose to 108 1-5 and pulse to 170. 
Friction baths of mustard in hot water were freely applied 
every hour, and her extremities were briskly rubbed with red 
pepper. And an enema of one tablespoonful of epsom salts 
with one teaspoon ful of salt placed in warm water was 
given every three hours ; and at the same time she was given 
every three hours a hypodermic injection of atropia sulphate 
1-150 and 1-30 grain of sulphate of strychnia. As soon as 
consciousness returned, which was as soon as the temperature 
fell to 105, she was given No, 3 every one and one-half hours 
until six doses were given, followed by salts ; and No. 5 was 
administered every four hours. Also Nos. 13 and 18 were 
given every three hours. And in order to avert any possible 
recurrence of the paroxysm in such a severe form, No. 30 was 
begun also as soon as consciousness returned. It is true that 
many physicians have given quinine hypodermically, but hy- 
podermic injections are often followed by such bad results 
that I prefer giving the quinine by the mouth. The temper- 
ature at the next recurrence was very slight indeed. The pa- 
tient was given the same treatment as already described. 
4 



CHAPTER VIII. 

THE COMATOSE TYPE OR ACUTE MALIGNANT CONGESTIVE INTER- 
MITTENT ANTICIPATING PER SE. 

Symptoms. The patient is seized with a cold stage or in- 
tensely hot stage. The temperature rapidly rises to from 104 
to 107. The main special diagnostic feature of this type of 
intermittent anticipating is the extreme irritability and acceler- 
ation of the pulse, being greatly out of all proportion to the 
rise of the temperature. In this type the pulse may be 150, 
while the temperature may not be more than 102% or io^ 1 /^. 
And in those cases where the temperature is 106 or 107 the 
pulse may be 180 or 190, or an irregular or running pulse; in 
the severest forms the pulse may be imperceptible at the wrist. 
Fortunately in this type such a severe attack does not often 
occur during the first attack, thus giving the careful physician 
an opportunity to prevent such a grave condition. The patient 
rapidly enters into a semi-conscious state, and he usually has 
a very bad faci?l expression. Now there is another very 
marked characteristic of this disease. The patient usually is 
totally intolerant to calomel in any form. For, since the 
bowels usually seem congested and blocked up in some way, 
calomel seems to still more aggravate and irritate the already 
inflamed bowels, thus causing increased acceleration of the 
pulse and often a rise in the temperature; and even in those 
cases in which the bowels are not locked up, a severe, uncon- 
trolable diarrhoea frequently occurs. 

Prognosis. This type is the most dangerous of all 
the malignant intermittent anticipating fevers. There is no 
disease that so closely needs the physician's most careful con- 
sideration as malignant intermittent congestive participating 
fever. The mortality in the severest types is about 10 per 
cent., and 8 per cent, of these die during the first attack, while 
only 2 per cent, die after the first attack, if properly treated. 

Treatment. As has already been referred to, calomel 

(50) 



The Comatose Type, etc. 51 

should be given with extreme caution. If calomel in any form 
is given, the pulse should be carefully watched, and if the 
pulse becomes more irritable and accelerated, the calomel 
should be omitted at once; or if the bowels should have any 
tendency to move frequently, calomel should not be given. 
In the same way if it is decided to give digitalis, veratrum, 
gelsemium, or aconite, the physician should watch at the bed- 
side to see if the pulse becomes accelerated, and if so then the 
medicine given is contraindicated ; for let it be distinctly re- 
membered that any medicines in these desperate cases are in- 
dicated only when they lessen the pulse rate, but are contraindi- 
cated if pulse becomes more irritable and accelerated. There- 
fore, there cannot be any certain medicines given in all types 
of this disease, for medicines act differently in different cases 
affected. However, a broad, general plan of treatment may be 
given, so that a careful attention to minute details will bring 
the case to a successful termination in 90 per cent, of the 
cases; but if very careful attention is not given them, 40 to 60 
per cent, of the cases will probably die. 

In the first place, the patient, if unconscious, should be 
given an enema of one-half gallon of tepid water, containing 
two teaspoonfuls of salt and the same amount of epsom salts ; 
which solution should be administered per rectum every three 
hours. One hour following the enema, the temperature and 
pulse should be taken to see whether or not the temperature 
and pulse have fallen, more especially the pulse. If the pulse 
should not be slower, then cold water might be substituted. 
At the same time tepid friction baths of a .9 per cent, chlo- 
ride of soda solution may be given every hour or two, and 
an ice bag or a cold cloth retained over, the forehead. And in 
order to rapidly reduce the temperature and pulse rate. I usu- 
ally begin with No. 13 every fifteen minutes for four doses, 
and then every thirty minutes for three more doses ; and then 
No. 13 is given every two hours. In the large majority of 
cases No. 13 rapidly reduces temperature and pulse rate; but 
if the pulse rate after three hours has not fallen, it should be 
abandoned entirely. Then No. 16 every hour should be given, 
but if it should not reduce the pulse rate within three hours, 



52 Typhoid and Other Fevers 

then administer No. n every three hours. Or No. n may be 
used from the beginning. Then give No. 5 every three hours, 
and No. 55 every hour. Also give No. 18 every four hours in 
plenty of water. But if the pulse continues to rise, then in 
such cases I have found that No. 27 as directed has often 
acted very efficaciously. And in these desperate cases bro- 
midia in one-half teaspoonful doses every two hours seems to 
do much good in allaying extreme restlessness. When the 
pulse is extremely weak, if the patient is unconscious, strych- 
nia sulphate 1-30 gr. and atropia sulphate 1-150 gr. should be 
administered hypodermically every three hours; but if con- 
scious, then per mouth. 

Just as soon as the temperature has reached near normal, 
it is always very important to see whether or not the pulse has 
reached near normal. Now, if the pulse has dropped as low as 
80 or 90 with a temperature not more than 100, it is not only 
perfectly safe, but very expedient to begin with No. 1 every 
one and one-half hours until four doses have been given; how- 
ever, if the bowels should act three or four times before third 
dose, then omit third and fourth doses. And quinine in the 
form of No. 34 may be given with No. 30; however, No. 
31 or 32 should also be given. And No. 18 should be contin- 
ued with one-half size doses of Nos. 13 and 11 as the case 
may be. If the pulse should become more accelerated at any 
time, quinine should be discontinued. Fowler's Solution in 
five to eight-drop doses should always be given every four 
hours; and if quinine in these forms could not be given, then 
give only No. 35 if possible, if not then No. 29 should be 
given every three hours. 

Clinical case No. 16. Mrs. J. R. had been having hot 
stages for two or three days in succession, when I was called 
in to see her during the exacerbation. Her temperature was 
105 and pulse 146; and she had a bad expression of the face. 
I gave her No. 1 every two hours till four doses were given, 
followed by salts; and she was bathed with warm Water and 
soda every three hours. She was given Nos. 11 and 18 as 
directed. But I learned that the onset had returned two hours 
earlier than previous day. On my visit I found her semi- 



The Comatose Type, etc. 53 

conscious. Her temperature was 106 3-5 and pulse 165. On 
inquiry I learned that her temperature had fallen to normal 
about 5 A. M. At that time she began with No. 30 every 
hour for five doses. And I learned that her bowels had not 
acted, though she had been taking No. 5 every three hours 
since 5 A. M. She was very irritable and restless. Fully re- 
alizing that her bowels were in a fearfully congested, inflamed 
condition, I gave her No. 27 every two hours, and I ordered 
her to be given an enema of a warm .9 per cent, solution of 
chloride of soda, and a warm friction soda bath every four 
hours. On my return next morning, her temperature was 
100V2 an( l pulse 124. I ordered the treatment of the previous 
night continued, and gave directions that if she didn't get 
along all right during the day to let me know. On my visit 
the following day her temperature and pulse were normal. I 
ordered the enema and friction bath to be omitted, and that 
No. 27 be given every four hours during the day, when it 
was to be gradually diminished until the following day, then 
discontinued. And she was given No. 18 before meals for a 
week. She soon completely recovered. 

Clinical case No. 17. On September 4, 1905, at 8 P. M., 
F. M., who had been having intermittent anticipating fever 
for a few days, was suddenly seized with a distinct hot stage 
with severe cramping in the stomach. His temperature soon 
rose to 104 and pulse to 136. He was given Nos. 1, 18 and 
11 as directed, and a warm friction bath containing soda was 
ordered every four hours. On the following morning his 
temperature was normal and pulse 84. No. 1 was repeated, 
and No. 30 was given every one and one-half hours until four 
doses were given. But at 6 P. M. he was seized with another 
paroxysm, without any distinct cold stage. The temperature 
rose to 105 1-5 and pulse 140. The treatment of the previous 
day was given him. On the following morning I found him in 
an apparently good condition, except that his lips were blue, 
with a red condition of the face. On my arrival I found his 
temperature 99 and pulse 88 and irritable, and I again placed 
him on a treatment similar to the previous day. However, at 
4 P. M. the hot stage returned again with increased severity. 



54 Typhoid and Other Fevers. 

I saw him at 8 P. M., and found him so delirious that he had 
to be restrained from leaping out of the window. His tem- 
perature was 1 06 2-5 and pulse 154. As I had noticed that 
his bowels had acted only with extreme difficulty, I became 
satisfied that the quinine and< calomel were aggravating his 
fever, and I decided that he needed something to allay the 
intense inflammation and irritability. I therefore ordered all 
previous medicines to be laid aside and gave only No. 2J every 
two hours. Warm friction soda baths were given every three 
hours. On the succeeding morning his temperature was 100 
and pulse 84. I had No. 2J and the baths continued for 
twenty- four hours, when his temperature was 98 and pulse 
72. Both the bath and No. 2j were gradually lengthened in 
duration for twenty-four hours, when they were abandoned. 
He made a rapid and complete recovery without quinine or 
calomel. 

Clinical case No. 18. Mrs. G. C. had been having antic- 
ipating intermittents for several days, when Dr. F. was called 
in. He gave her large and repeated doses of calomel during 
the fever, with three-drop doses of flu. ext. of digitalis and 
five-drop doses of Fowler's Solution, and gave her during the 
intermissions large and frequent doses of quinine. But every 
successive onset returned earlier and in a more aggravated 
form. And when I saw her, her temperature was 105 and 
pulse 165. She was in a semi-conscious condition. I learned 
on inquiry that her bowels had acted only twice within a week, 
and then only with the greatest difficulty. Seeing that pur- 
gatives and quinine had given no results, we gave her the 
following line of treatment: She was given as directed No. 
13 with five-drop doses of Fowler's Solution. At the same 
time warm soda solution friction baths and enemas were or- 
dered every two hours. But after three hours the pulse had 
risen to 172 and temperature 1043-5. Therefore, No. 13 was 
omitted and No. 58 substituted every three hours. Also No. 

55 was given every half hour, and, in addition to this treat- 
ment, atropia sulphate 1-150 and sulphate of strychnine in 1-60 
grain doses were administered every three hours hypodermic- 
ally. Soon the pulse and temperature began to drop, until by 3 



The Comatose Type, etc. 55 

A. M. the temperatutre was 103 and pulse 148. Perceiving that 
the pulse was entirely too rapid for such a low temperature, 
strychnine sulphate was increased to 1-30 and nitro-glycerine 
in 1-200 grain doses were added every three hours; and, in 
addition to this, fluid extract of digitalis in two-drop doses was 
added with No. 8, and continued as before. At 7 A. M. the 
temperature was 101V2 and pulse 134. On account of the 
accelerated and irritable pulse, no quinine was given. How- 
ever, in order to allay irritability, No. 59 was given also. At 
12 M. the temperature was normal and the pulse was 120. 
But the patient had a bad facial expression. Fearing another 
recurrence, as no calomel or quinine were given, and since we 
feared to entirely check all secretions as with No. 27, we de- 
cided to give every two hours No. 13. As a result, the temper- 
ature fell to 96 and pulse to 90 by 8 P. M., when No. 2y was 
given in only one-half-size doses. After six hours No. 2j 
was lengthened to four hours. Then the solution for the 
enema and friction baths was withdrawn altogether. The 
patient completely recovered within a week. 



CHAPTER IX. 

REMITTENT FEVER. 

Symptoms. In this form of Malarial Fever there are 
three distinct stages — the onset, the exacerbation and the de- 
cline. The onset is ushered in with a distinct chill or rigor, 
usually between 8 A. M. and 12 M., which is quickly fol- 
lowed by the stage of exacerbation. During the second stage 
the temperature may rise to 105 and the pulse to 120 or 130. 
The declining stage rapidly supervenes after the second stage. 
During the third stage the temperature and pulse slowly fall 
until almost normal temperature and pulse rate supervene, 
when at this time there is a recurrence of the onset followed 
by exacerbation and decline. 

Prognosis. The prognosis is always good. And the du- 
ration of the disease is from three to eight or ten days. 

Treatment. The patient may be given No. 1 for four or 
five consecutive days. At this time, if the bowels have be- 
come too loose, if the pulse has become too irritable, or if 
there is found mucous in the discharges, calomel may be 
omitted for forty-eight hours and No. 23 given to allay the 
irritability. Also from the very beginning Nos. 18 and 11 
may be given. And as soon as the normal temperature is 
reached No. 30 or 33 may be given every thirty minutes till 
six doses are given if no fever. And on every successive re- 
currence of the intermittent period Nos. 30 Spa 33 should be 
given every thirty minutes until six doses are given. As the 
duration of the intermission becomes longer, the intervals be- 
tween the doses of quinine may be lengthened. And, in ad- 
dition to No. 30 or 33, if the disease is not being sufficiently 
controlled, No. 34 or 35 may also be added. In this way the 
onset will continue to recur later and the intermission earlier, 
until finally, within three to ten days, the fever will be aborted. 
After the subsidence of the fever, treatment as given in in- 
termittents after subsidence of fever may be administered. 

(56) 



Remittent Fever. 57 



Clinical case No. 19. T. M. had a severe rigor at 8 A. M. 
on the 5th clay of November, 1901. A few hours after the 
rigor the period of exacerbation began. During this stage 
the temperature rose to 105 and pulse to 124. And this stage 
continued until 8 P. M., when the stage of decline began. The 
temperature dropped to 101 and pulse 100 at 5 A. M. f and 
the temperature and pulse rate remained at about this height 
when the rigor recurred. 

Treatment. I ordered Xo. 1 to be given as directed; also 
No. 18 was ordered before meals and No. 11 every four hours 
during the fever. This line of treatment was continued until 
the 9th, at 2 A. M., when the normal temperature was reached. 
No. 30 was given every thirty minutes until four doses were 
given, when the onset occurred. Then No. 1 every one and 
a half hours; Nos. 18 and 12 were given every four hours. 
As a result of the treatment the intermission recurred earlier 
and the onset later, until on the 13th No. 30 was given every 
two hours with two doses of No. 34. when the temperature 
remained at the normal. After this time the fever was treated 
as intermittents. In this way the patient was discharged. 

Double remittent fever. The patient is seized with a 
chill or rigor, usually between 8 A. M. and 12 A. M. And after 
a few hours the period of exacerbation occurs. During this 
period the temperature may rise to 105 and pulse to 120 or 
130. Then between 1 P. M. and 4 P. M. the declining stage 
begins. During this stage within three or four hours the 
temperature slowly declines to nearly normal, when the sec- 
ond exacerbation occurs. During the second exacerbation the 
temperature rapidly rises to its previous height, where it re- 
mains stationary until the second decline. And during the 
second declining or remitting stage the temperature again falls 
to nearly normal, when a recurrence of the symptoms of the 
previous day takes place. 

Prognosis. The prognosis is always good when properly 
treated. And the duration of double remittent is from three 
to twelve days. 

Treatment. The patient should be given Nos. 3, 18 and 
11 as directed. Close attention should always be paid to the 



58 Typhoid and Other Fevers. 

time of remissions, in order to detect the slightest intermit- 
tence. During an intermittent period No. 30 should be given 
every fifteen minutes until six doses have been given, unless 
fever recurs, then omit the quinine. And also, in addition to 
No. 30, one dose of No. 34 may be given. In this 
way the period of intermission will gradually lengthen, thus 
soon permitting twelve doses of No. 30 to be given. And as 
soon as possible the intervals between the doses of No. 30 
should be gradually lengthened until given every two hours. 
Then double remittent may be aborted in the same way as 
a remittent fever. 

Clinical case No. 20. At 9 A. M., on Sept. 4th, Mr. J. 
B. was seized with a distinct rigor, which was soon followed 
by the exacerbation. During this period the temperature 
rose to 104 3-5. At 12 A. M. the temperature began to decline 
until it dropped to 102, when, at 4 P. M., the second exacer- 
bation occurred. Then the temperature rapidly rose to 105 2-5 
and pulse to 138 at 5 _P. M. And the temperature and pulse re- 
mained stationary at this height until 12 P. M., when the sec- 
ond decline began, and the temperature and pulse gradually de- 
clined until the temperature was 102 and pulse 116 at 6 A. M. 
And the recurrence of the onset took place by a distinct rigor 
at 8 A. M. ; and the symptoms were similar to those of the 
previous day. 

Treatment. No. 3 was given every one and a half hours 
until four doses were given, followed two hours after the last 
dose by salts. Also Nos. 11 and 18 were given. As soon as 
the second exacerbation occurred one-sixth grain of cal- 
omel was given every fifteen minutes until six doses were 
given ; and No. 1 was given every one and a half hours until 
four doses were given. On the following morning, the onset 
having recurred near the same time of day as on the previous 
morning, the treatment was ordered to be carried out in the 
same manner as in the previous twenty-four hours. On Sept. 
6th the onset did not recur until 10 A. M. No. 1 every one 
and a half hours was substituted for No. 3, and the remaining 
treatment was ordered as given the two previous days, ex- 
cept that the one-sixth grain of calomel and No. 1 given in the 



Remittent Fever. 



afternoon were omitted, as the bowels were acting freely. 
On the 7th, at 4 A. M., his temperature was 99 3-5. At this 
time he was given No. 30 every hour for four doses, when, 
the temperature having risen to 10 1 1-5, the quinine was 
omitted. The treatment of previous day was given. On the 
8th, at 3 A. M., the temperature had fallen to 98 1-5. He 
was given No. 1 every fifteen minutes for six doses, and No. 
34 as directed. The temperature did not rise until 12 A. M. 
At 2 P. M. the temperature rose to 102 2-5. At 8 P. M. the 
temperature had fallen to 100, when the evening exacerbation 
recurred. During the exacerbation the temperature rose to 
103 2-5 and pulse 118. The decline began at 12 P. M., and at 
2 A. M. the temperature had fallen to 98, when treatment of 
previous day was given. The fever did not return any more. 
He was treated as in the remittent type, and soon completely 
recovered. 



SECTION III. 



CHAPTER I. 



ESTIVO-AUTUMNAL AND TYPHOID FEVERS. 

It is better from a practical, clinical, diagnostic, thera- 
peutic and prognostic standpoint to place estivo-autumnal and 
typhoid fevers under the head "slow fevers" for the following 
reasons : 

(i) There is acute inflammation of the mucous mem- 
brane of the intestinal canal and mild inflammation in the air 
passages in both diseases. (2) The step-ladder-like ascent of 
the temperature in typhoid fever is of no diagnostic impor- 
tance, for such symptoms are often present in other diseases. 
(3) The rose-colored spots are not always present in typhoid, 
while, too, the rose-colored spots may occur in estivo- 
autumnal fever. (4) The typhoid tongue may sometimes 
occur in any deep-seated disease when the stomach is involved. 
(5) The spleen and liver are both enlarged in estivo-autumnal 
and typhoid fevers. (6) Peyer's Patches are of no diagnostic 
importance clinically, since they cannot be proved to be pres- 
ent until after death ; and, besides, they have often been found 
to be present in cases not even suspected of being typhoid 
fever. (7) Epistaxis may occur in both diseases. (8) The 
Diazo-Reaction Test is of no diagnostic importance. For 
Nothnagel says in regard to the diazo-reaction test : "In addi- 
tion the reaction occurs with especial frequency, almost inva- 
riably in other febrile diseases, and particularly such as offer 
difficulty in differential diagnosis, especially miliary tubercu- 
losis and florid forms of miliary tuberculosis, typhus fever, 
certain forms of profound pneumonia, malaria, and finally 
exanthemata, particularly measles." (9) The Widal Test is 

(60) 



Estivo and Typhoid Fevers. 61 

of no diagnostic importance in typhoid fever, since pertaining 
to the Widal Test in typhoid fever as a diagnostic sign An- 
ders says: "If this specific reaction is not obtainable in a case 
sick over*a week, typhoid fever may be excluded." But at 
the same time in another place Anders has this to say: "It 
is to be remembered, however, that in persons who have had 
typhoid fever within ten years the reaction may take place." 
Therefore, their presence is of no diagnostic importance, since 
the presence of the reaction may be due to some previous 
attack. (10) Hemorrhage of the bowels is of no diagnostic 
importance, since it is known that hemoglobinuria or hema- 
turia is due to malarial parasites ; so if malarial parasites cause 
hemorrhage of the kidneys, why not cause hemorrhage of the 
bowels? Then, too, dysentery occurs only in a malarial dis- 
trict. And Nothnagel says : "A rare occurrence is intermittent 
hemorrhage from the bowels in malarial fevers." And in 
another place he says : "They become important on account 
of the diagnosis (possible confusion with typhoid fever) or 
treatment." And to make it the more impressive that there 
is no diagnostic clinical signs of typhoid fever, I shall here 
quote the words of Osier concerning the resemblance between 
typhoid and estivo-autumnal fevers. He says: "In some cases 
the resemblance to typhoid fever is very remarkable, epis- 
taxis, an eruption and gurgling in the right iliac region, being 
present In fact, in many of these cases it is impossible to 
make a diagnosis between malaria and typhoid fevers without 
the aid of a microscope." 

And I further propose to show that it is impossible, even 
with the aid cf a microscope, to absoluuely prove that there is 
any marked difference between typhoid and estivo-autumnal 
fevers. 

In the first place, Xothnagel, Osier and other eminent 
observers declare that the crescents that cause estivo-autumnal 
fevers are found only in the internal organs ; and they further 
declare it a very dangerous procedure to puncture the spleen 
in search of the crescents. And so, not finding the crescents, 
it would not be absolutely certain that the disease is estivo- 
autumnal. And in the next place, the presence of crescents 



62 Typhoid and Other Fevers. 



is no absolute proof that the fever is due to malarial parasites, 
for Nothnagel says: "Practically all the native children in 
the tropics, apparently healthy, harbor parasites and are ca- 
pable of infecting mosquitoes." Therefore, if these parasites 
are found in health, it is impossible to know that the fever 
is always due to parasites. 

Furthermore, there is no absolute proof that the typhoid 
bacillus is the sole cause of typhoid fever. Pertaining to 
typhoid bacilli as the cause of typhoid fever, Hektoen and Ries- 
man say : "No one who works with the two groups of bacilli, 
the colon and the typhoid, and especially with the intermit- 
tent forms, can fail to be impressed with the narrow margin 
of physiological differentiation separating them. Many are 
now inclined to consider typhoid bacillus unaltered morpholog- 
ically, but with a few acquired physiological characters, prob- 
ably due to its more or less prolonged sojourn under sapro- 
phytic conditions. This view, proclaimed by Rodet and Roux 
about ten years ago, has been steadily gaining ground." And 
in another place Hektoen and Riesman, in discussing reju- 
venated colon bacilli, say: "Many of the acquired character- 
istics make a suspiciously typhoid-like behavior in a so-called 
colon bacilli." 

And, besides, the probability that a colon bacilli is nothing 
more than a rejuvenated colon bacilli, as has been said pre- 
viously, typhoid bacilli may remain in the blood for ten years. 
And therefore, even if found, it is not absolutely certain that 
they are the cause of an existing fever. 

And so an attack of estivo-autumnal fever with crescents 
in the spleen may be wrongly called typhoid fever, simply 
because old typhoid bacilli had existed in the blood for ten 
years. Or such a case, continuing only a week, may be 
wrongly diagnosed as abortive typhoid fever. Therefore it is 
impossible to absolutely prove that typhoid bacilli are the 
sole cause of typhoid fever. 

As there is no especial diagnostic differentiation between 
typhoid and estivo-autumnal fevers, I shall therefore desig- 
nate both of these fevers under the head of "slow fevers." 

Slow fevers. It is better to describe typhoid and estivo- 



Estivo and Typhoid Fevers. 63 

autumnal fevers under the head of slow fevers for the fol- 
lowing reasons : 

The severe grades of continued malarial fevers have 
rarely been described in text-books. For it is shown in all 
text-books that there are different grades of severity of inter- 
mittent fevers, while all the different grades of continued ma- 
larial fevers are described under remittent, double remittent, 
or estivo-autumnal fevers. As there are all grades of severity 
of any disease, it is only natural to conclude that there are also 
different grades of remittent fevers. When we conceive of 
a severer grade than a remittent or estivo-autumnal, we con- 
ceive at once a continued fever closely resembling typhoid 
fever. And since there is no differential diagnosis between 
these fevers, great errors may result in the management of 
these fevers. As a result of calling such fevers typhoid 
fever, only a supportive treatment may be used, thus probably 
causing the patient to die for the lack of proper anti-malarial 
remedies. 

Therefore I shall treat estivo-autumnal and typhoid 
fevers under the head of "slow fevers." 



CHAPTER II. 



SLOW FEVERS. 



Etiology. Slow fevers are due to some form of irrita- 
tion from without or within. But the main, deep, underly- 
ing causes of slow fevers, are faulty action of the vaso-motor 
systems and the lack of the isotonic conditions of the blood. 
For even if parasites or bacilli should enter the system by 
the alimentary canal, air passages or blood, the patient will re- 
main in good health so long as the resistance of the individual 
is sufficient to ward off the disease, because in such cases the 
isotonic conditions of the blood and vaso-motor apparatus are 
in normal equilibrium. 

Morbid anatomy. There is found more or less irritation 
and inflammation of the mucous membrane of the intestinal 
canal, as is often evidenced by the vomiting of bile, being due 
to inflammation in the region of the bile duct ; and the deeper 
the underlying tissues are involved the more severe the in- 
flammation. And more or less inflammation of the structures 
in the air passages is usually present. When sequela or com- 
plications occur, the mucous membrane and underlying tissues 
of the stomach may become inflamed, or the inflammation of 
the kidneys may occur. 

Prognosis and duration of disease. The prognosis de- 
pends upon the severity of the disease and upon sequela and 
complications present. But the mortality, even in the severest 
grades, is not more than one per cent. The duration of the 
disease, when properly treated, is never more than from three 
to fourteen days. 

General considerations. Broadly speaking from a clinical 
standpoint, it is evident that all acute inflammatory diseases 
are named from the abnormal amount of blood collected in 
the area affected, for if collected in the lungs, thus causing 

(64) 



Slozv Fevers. 65 



the congestion of the lungs, we call the disease pneumonia; 
in bronchioles, bronchitis ; in the meninges, meningitis ; in the 
kidneys in small amount, nephritis; if in large amount, hema- 
tura, or hemoglobinuria. And in the same way, if an abnor- 
mal amount of blood be collected in the intestinal canal, the 
disease is called enteritis, enterocolitis, the different forms of 
malarial fevers, typhoid fevers and estivo-autumnal fevers, etc. 
And, therefore, if we look at all acute inflammatory diseases 
only from a broad, practical, clinical standpoint, there is not 
then seen the wide differences between these diseases as are 
often supposed to exist between them. And we shall look at 
diseases rather from this standpoint, in order to more clearly 
set forth how all acute inflammatory diseases of the intestinal 
canal, together with all possible complications and sequela, 
may be brought to a successful termination within fourteen 
days with a minimum mortality. 

And in order to more strongly impress the reader that 
slow fevers may be broken within fourteen days, with mini- 
mum mortality, the following facts^ may be briefly set forth : 
In the first place, many forms of acute inflammatory diseases 
have not only been lessened in mortality, but also shortened 
in duration. For instance, it is well known that twenty-five 
or thirty years ago acute inflammatory rheumatism under 
strictly alkali treatment would continue from four to six or 
ten weeks. But with a careful, judicious administration of 
salicylates in some form, together with the alkaline treatment 
and other proper remedies, not only has the mortality of acute 
inflammatory rheumatism declined to a minimum, but also 
the duration of the disease has been shortened to only three to 
fourteen days. In fact, for eighteen years I have shortened 
every case to within fourteen days without any mortality. 

And, in the next place, it must be admitted that great im- 
provement has been made in the more successful management 
of typhoid fever since the discovery in 1880 of the typhoid 
bacillus of Eberth. For not only has the mortality of typhoid 
fever been lessened in number, but great improvement has 
been made in the methods of preventing the formation and 

spread of the disease since 1880. But the duration of the dis- 
5 



66 Typhoid and Other Fevers 



ease has not been diminished in the least, on account of the 
following reasons : ( I ) As typhoid fever has been always con- 
sidered as a self-limited disease, no attempt has been made to 
abort the disease. (2) As the disease is considered a self- 
limited disease, no attempt has been made to abort any disease 
resembling .typhoid after a week of continued fever. (3) 
And because, as has already been shown, the so-called diag- 
nostic signs of rose-colored spots, diazo-reaction test, "Widal 
Test," the presence of so-called typhoid bacilli, etc., have erro- 
neously been held as absolute diagnostic signs of typhoid fever. 
As a result of such conclusions, physicians have not even at- 
tempted to abort typhoid fever. For it has been declared 
that any attempt to shorten the disease will increase the mor- 
tality ; but such a statement is incorrect, as shall be conclusively 
proved in this work. 

Anyone must admit that clinical medicine has advanced 
not only in direct proportion to how much mortality has been 
lessened and disease itself decreased, but also in direct pro- 
portion to how much disease has been shortened in duration. 
Now, the discovery of parasites has not lessened the duration 
of typhoid fever, for no attempt has been made to abort the 
fever. 

The phenomenal success for twelve years that I have had 
in aborting slow fevers with a minimum mortality even in the 
severest cases led me to set this work before the public. And, 
in order to clearly set forth how to abort these fevers, it is 
necessary to show by successive steps just how I became suf- 
ficiently experienced to abort these fevers within fourteen 
days with a minimum mortality, for in aborting these fevers 
I opposed the commonly accepted theory that it is more dan- 
gerous to abort slow fevers than to treat them on the support- 
ive plan. 

Now, I first conceived the idea that typhoid fever might 
possibly be lessened in duration from the following facts : In 
1889, Quine, with many other eminent observers, declared 
that the clearing up of densely timbered regions where malarial 
intermittents prevailed usually caused typhoid fever. But 
on reflection I concluded that if there really was as much 



Slow Fevers. 67 



difference between a malarial parasite and a typhoid bacilli as 
is supposed to exist between them, that then a malarial para- 
site should not develop into another distinct micro-organism, 
the typhoid bacilli, no sooner than would a grain of wheat 
spring up and develop into oats. Looking at the result of 
clearing up of timbered regions in malarial districts from this 
standpoint, I concluded that continued malarial fevers and not 
typhoid fevers took place ; for, then, the malarial poisons that 
otherwise would have lodged in the timber floated in the air. 

In 1890 I held the idea that Osier now holds pertaining 
to all types of malarial fevers ; and that is that all types of 
malarial fevers may be aborted within a week. And, in order 
to prove conclusively whether or not such cases as diagnosed 
as typhoid fever were typhoid fever I treated 75 per cent, of 
the continued fevers as typhoid fever, and 25 per cent, as 
malarial fever. In the J$ per cent, treated as typhoid fever 80 
per cent, continued longer than fourteen days, with a mortality 
of 12 per cent.; but in the 25 per cent, treated as continued 
malarial fevers 80 per cent, of these were aborted within four- 
teen days without any mortality. 

In 1891 I treated 50 per cent, of all the continued fevers 
as typhoid, and 50 per cent, as continued malarial fever. In 
the continued forms treated as typhoid 85 per cent, of these 
continued longer than fourteen days, with a mortality of 10 per 
cent. ; but in the cases treated as continued malarial fevers 80 
per cent, of the same were aborted with 2 per cent, mortality. 

Then in 1892, I perceived that all the cases treated on the 
abortive plan, even if such continued longer than fourteen 
days, pursued a much milder course than those that were 
placed upon a distinct supportive plan. Therefore I decided 
to treat all continued fevers on the abortive plan for five days. 
And so, after treating all cases on the abortive plan for five 
days, I then treated 50 per cent, on the supportive plan as 
typhoid fever, and 50 per cent, on the abortive plan. In this 
way 10 per cent, were aborted within five days. Of the other 
50 per cent, that twere treated as continued fever only 50 per 
cent, continued longer than fourteen days, with a mortality of 
only five per cent. ; and of the remaining 40 per cent, that were 



68 Typhoid and Other Fevers. 

treated on the aoortive plan 80 per cent, of these were aborted 
within fourteen days, with a mortality of 1 per cent. 

In 1893, perceiving that there was a much less mortality 
when the continued fevers were treated on the aBortive plan 
than when treated on the supportive plan, I decided to treat 
all cases on the abortive plan for five days, and treat 80 per 
cent, of these cases on a continued abortive treatment throughout 
the disease; and 20 per cent, of the cases were treated on a 
supportive plan. At the clase of the year I found that 14 
per cent, of the cases were aborted within fourteen days; in 
the other 66 per cent, of the cases treated on the abortive plan 
about 80 per cent, of these were aborted with a mortality of I 
per cent. ; but of the 20 per cent, of the cases treated on the sup- 
portive plan 50 per cent, continued longer than fourteen days, 
with 4 per cent, mortality. 

In 1894 I decided to treat all cases on the abortive plan. 
But I had become convinced that a still more judicious use 
of medicines would aid me in materially lessening the mor- 
tality and the duration of the disease. The indications and 
contraindications of these remedies will be referred to later. 
During 1894, 94 per cent, of the cases were aborted without 
any mortality. 

In 1895 the same plan of treatment was carried out as 
during 1894; but, as a result of the experience in the more 
judicious use of the medicines used in aborting these fevers, 
100 per cent, of all the continued fevers were aborted within 
fourteen days without any mortality. 

Then in 1896 I continued the same plan of treatment, but 
only 90 per cent, were aborted, with a 2 per cent, mortality. 
However, during this year some valuable clinical experience 
was gained. For I perceived that hemorrhage may be diag- 
nosed twenty-four to forty-eight hours before the drop of 
temperature; and since 1898 I have had but one hemorrhage 
of the bowels in cases treated by me from beginning of the 
disease. 

And so in 1898 I concluded that all forms of typhoid and 
estivo-autumnal fevers may be aborted within fourteen days, 
with a minimum mortality. And so with the reasons already 



Slozv Fevers. 69 



adduced 1 placed both the estivo-autumnal and typhoid fevers 
under one head, "slow fevers." And though twelve years 
have elapsed since I first designated both these fevers under 
the name of "slow fever," I have aborted every case of even 
the severest grades with all their complications and sequela 
with but three deaths from "slow fevers" -ince that time. 



CHAPTER III. 

CLINICAL EFFECT OF SOME COMMON REMEDIES USED IN SLOW 

FEVER. 

In order to clearly show how to abort these fevers with a 
minimum mortality, it is absolutely necessary to briefly refer 
to some of the most common remedies used in aborting "slow 
fevers." And I shall give the action* of such remedies only 
from a clinical standpoint as seen in clinical medicine; and 
shall further point out when such remedies are indicated and 
when contraindicated. 

Calomel. It is claimed by many observers that calomel 
weakens the patient, and may even destroy life itself. 

Now, it is true that calomel wrongly given causes irrita- 
tion and inflammation of the mucous membrane of the intesti- 
nal canal in some cases; but such a condition may always be 
detected by an increased acceleration of the pulse or increased 
temperature in such cases. And then when the pulse becomes 
irritable, if calomel should be continued, mucous or dysenteric 
discharges may then occur. 

And in some cases calomel may cause the bowels to act 
too freely, as eight or ten times within twenty-four hours; 
then calomel should be omitted. And if calomel be continued 
too long, profuse, weak sweating will occur at the declining 
stage. In order to avoid this danger, calomel should not be 
given after the temperature has fallen to 100 or 101. 

Furthermore, if calomel should be doing harm, as evi- 
denced by a more irritable and accelerated pulse on 
every successive day that calomel is used, then a con- 
tinuance of the drug may not only cause increased irri- 
tability and acceleration of the pulse, and higher temperature, 
but may in such conditions cause hemorrhage of the bowels. 
Therefore, calomel is contraindicated when the pulse and 
temperature continue to rise with the use of calomel after the 
first four days. 

(70) 



Clinical Effect of Some Common Remedies Used. 71 

Now, any patient is gradually growing worse so long as 
his temperature and pulse rate on every consecutive day grow 
higher and higher than they were at the same hour on the 
previous day. And it is my experience that no fever should 
rise in this way for more than four or five days. And so 
calomel usually may be given with perfect safety during this 
time. But after that time calomel may be safely given only so 
long as when the pulse rate and temperature are not increased 
higher than that of the preceding day at the same hour. 

Also calomel should not be given in those cases that the 
bowels move with great difficulty, or in those cases where the 
patient has become salivated. And calomel should always be 
given with extreme caution to those who had already been 
taking purgatives before the physician was consulted. Calomel 
is always contraindicated in those cases with a very rapid and 
irritable, or sclerosed pulse, and in a threatened hemorrhage 
of the stomach or bowels ; and calomel is contraindicated in a 
patient where there is total loss of proportion between the 
pulse rate and temperature, as, for instance, when the pulse 
is rising while temperature is falling, or vice versa. Calomel 
is a diuretic and antipyretic (but if it does not act as 
slightly anti-pyretic, it is contraindicated). 

Sulphate of magnesia.. In those cases of acute inflam- 
matory fevers in which calomel moves the bowels with great 
difficulty, common epsom salts may be given in small doses 
per mouth and enema to move the bowels. Also in acute dys- 
entery or enteritis, where calomel has not seemed to do good, 
salts may be given for twenty-four to forty-eight hours. 

Phosphate of soda may be substituted for sulphate of 
magnesia. 

Purgatives. Any form of purgative is indicated only so 
long as it after four days decreases the daily temperature 
and pulse rate, and so long as the bowels do not act more than 
three to five times daily. In fact, the indication and contra- 
indication of calomel give a pretty fair indication or contra- 
indication of other purgatives or cathartics. 

Digitalis. The action of digitalis in disease seems to be 
that of a vaso-dilator, thus causing an increased flow of blood 



J2 Typhoid and Other Fevers. 

toward the internal organs, thus naturally causing constriction 
toward the periphery. As a result of the use then of digitalis 
in disease, the heat is increased in the internal organs and 
diminished at the periphery. Therefore, digitalis is indicated 
in those cases where the temperature under the axilla is 
higher than per rectum or per mouth. Digitalis is also a 
diuretic, and gives more power and tone to the heart muscle 
itself. But it must be distinctly remembered that digitalis is 
contraindicated in all those cases in which the pulse and tem- 
perature continue to rise after the first four or five days. 
Therefore, digitalis may be given to those patients with a 
good expression and warm extremities. 

Sparteine, strophanthus, cimicifugse, cactina and cactus 
may sometimes be given as substitutes for digitalis. 

Veratrum. Veratrum is a powerful vaso-constrictor in 
disease. Therefore, veratrum causes more or less rapid flow 
of blood from the internal organs toward the periphery, thus 
naturally resulting in a lessened amount of blood in the in- 
ternal organs w T ith increased amount toward the periphery; 
and so blood pressure is rapidly lowered. As a result of the 
constriction of the internal blood vessels and dilatation of 
the periphery, heat formation is decreased and heat dissipa- 
tion diminished. My experience with veratrum has been 
identical with Dr. Horatio Wood, Jr., and Dr. Norwood. I 
find it a stimulant to the heart and not a depressant. How- 
ever, I have never given veratrum in more than three minim 
doses every fifteen minutes for three or four doses (except in 
uraemic convulsions) every thirty minutes, for three or four 
doses longer; every hour for two or three doses, and after this 
time every two hours for from four to five days. After four 
or five days, I prefer to give digitalis, unless the temperature 
and pulse have begun to fall rapidly by that time. 

Precautions in giving veratrum. In order to avoid any 
danger in giving veratrum, I usually add .nitro-glycerine 
in i -200 or 1-300 grain doses. And if the following symp- 
toms occur, veratrum should always be lessened in amount 
or omitted altogether if the temperature too rapidly falls to 
near normal; when it falls to normal, if too profuse sweat- 



Clinical Effect of Sonic Common Remedies Used. 73 

ing; if too severe vomiting (the mere being somewhat sick 
at the stomach should be ignored) ; and the veratrum is always 
contraindicated if the temperature and pulse rate should con- 
tinue to rise for twenty-four or forty-eight hours after the 
commencement of the medicine.* And as veratrum is a pow- 
erful vaso-constrictor, thus being indicated with an inter- 
nal temperature of from two to five degrees more than ex- 
ternal temperature, it must always be distinctly remembered 
that the excessive long use of veratrum in such cases may 
cause the external temperature to rise from two to seven or 
eight degrees above the internal temperature. 

Veratrum in uraemia. There is no other remedy that 
will so quickly and successfully control acute uraemia or 
puerperal convulsions and haemoglobinuria as will veratrum. 
I have had eight cases of puerperal convulsions, and twelve 
cases of uraemic convulsions in children without any mor- 
tality since I began the use of veratrum. But in pueperal 
convulsions it is necessary to give hypodermically as much as 
ten to fifteen minims at a dose. It is true that in such large 
doses often repeated that the patient will often become entirely 
pulseless at the wrist. However, by the temporary omitting 
of the veratrum, while at the same time is given frequent hypo- 
dermic injections of 1-30 grain of strychnia with 1-150 grain 
of atropia, the same will soon overcome the large doses of 
veratrum. 

Indications for veratrum. Veratrum is especially in- 
dicated in all those acute inflammatory diseases where there is 
more or less sudden flow of blood in the internal organs or 
brain, as in pneumonia, haemoglobinuria or hematuria, menin- 
gitis, and in a threatened apoplexy, as shown in sclerosed pulse 
and repeated paleness and flushing of the face. And verat- 
rum may be given so long as the temperature and pulse rate 
fall and rise together. 



* However, it is probable, as stated by H. Wood, that larger doses, 5 or 6 M., 
at a dose may reduce the fever; but I have had no'experience in larger doses than 3 
minim size doses, (except in puerperal convulsions), and especially if the axillary 
temperature by that time has become much higher than the internal temperature 
per mouth. 



74 Typhoid and Other Fevers. 

Aconite. Aconite is a vaso-motor constrictor. It lowers 
blood pressure in some respects similar to veratrum, but in 
one to two drop doses aconite cannot be as safely given for 
as long a time as veratrum. Aconite acts somewhat simi- 
lar to veratrum in relieving blood pressure in the head as 
threatened apoplexy or meningitis, but is a heart depressant. 
But there is one portion of the body in which aconite acts 
by far more rapidly and more efficiently than any other known 
remedy, namely, any acute affection of tonsils with their ad- 
jacent tissues. But I usually prefer not to give aconite any 
longer than from two to five days. 

Contraindications. Aconite should not usually be given 
for more than forty-eight hours at a time, except in head or 
throat involvement; and aconite should not be given when 
temperature is below normal; and cold, clammy sweats con- 
traindicate its use. 

Indications. Aconite may be given, however, in any dis- 
ease only so long as it causes the temperature and pulse to rise 
and fall together. 

Gelsemium may also be given so long as it lowers tem- 
perature and pulse rate. Gelsemium usually allays irritation 
of the nervous system to a remarkable degree ; but it is such a 
depressant that it should not be given for longer than forty- 
eight to seventy-two hours in slow fevers. Gelsemium is 
wholly contraindicated in pneumonia, but it seems to act very 
efficiently in those cases of threatened meningitis or apoplexy, 
or in any other disease in which veratrum or digitalis has 
failed to decrease the pulse and temperature. 

General considerations of digitalis, veratrum, gelsemium 
and aconite. From a broad standpoint, the following may be 
said concerning digitalis, veratrum, gelsemium and aconite: 
Any of these remedies may be administered only so long as 
they lower temperature and pulse rate; and if any of these 
remedies fail to do this, they should be omitted. These are 
the following conditions that may prevent aconite, veratrum, 
digitalis and gelsemium from lowering the pulse rate and bodily 
temperature: (i) Difficulty in the action of the bowels, and 
hepatitis or peri-hepatitis and some abnormal condition of the 



Clinical Effect of Some Common Remedies Used. 7; 

vasomotor capillary system. ( 2) Also an empyema will prevent 
these remedies from lowering the pulse rate and temperature, 
proportionally. 

Nitro- glycerine. Xitro-glycerine is a vasomotor con- 
strictor ; it is especially given where there is a bad expression 
of the face due to the faulty action of the vaso-motor capil- 
lary systems, and it may be given especially when the tempera- 
ture is subnormal. 

Strychnine. Strychnia is a powerful heart and respira- 
tory stimulant. It may be given to improve the facial expres- 
sion. Strychnia may be given in all those diseases where 
there is no irritability of the pulse. It may be especially given 
with a slow pulse and high temperature, or vice versa. And 
strychnia is indicated with a slow pulse and subnormal tem- 
perature. Strychnine is usually indicated near the close of 
any acute inflammatory fever. But strychnia should be cau- 
tiously given when there is a zigzag temperature or pulse 
rate, when the temperature is rising while the pulse is falling, 
or vice versa. Strychnia should not be given in meningitis, 
severe inflammation in the bowels, or in the early -tages of 
pneumonia. My experience coincides with that of Hare, who 
says that strychnia should be given in the same way that a 
whip is used on horses, only to urge them through tight 
places. 

Atropia. Atropia is a respiratory stimulant, and is es- 
pecially indicated to aid equilibrium of the vaso-motor capil- 
lary systems. If atropia is given too long, it may increase 
bodily temperature and accelerate the pulse, which are caused 
by the increased heat production, while at the same time there 
is lessened heat dissipation. There is no remedy that is more 
beneficial to prevent over-secretion during the crisis of acute 
inflammatory diseases, as pneumonia, than atropia. There- 
fore, at the beginning of crisis, or sooner in desperate cases, 
atropia sulphate in 1-150 to 1-200 grain doses should be begun, 
if not already being cautiously given, every three hours, since 
over-secretion in the lungs and bronchial tubes is the direct 
cause of the majority of deaths in pneumonia and a number of 
deaths in slow fevers. But at the same time it must always 



76 Typhoid and Other Fevers. 

be remembered that the too long continued and too often re- 
peated doses of atropia may prevent sufficient secretion of 
mucous during the third stage of pneumonia, and may also 
prevent sufficient secretion of the periphery and mucous 
membrane in the alimentary canal. Now, in such cases in 
pneumonia, as a result of the lessened secretion, pneumonia 
may decline by lysis instead of crisis, and as a result the 
lungs, not having cleafed normally, there remains more or less 
consolidation. Fortunately, however, if the physician im- 
mediately places such a patient on tonics that are at the same 
time not severe on a weak stomach, he will completely recover. 
Such tonics may be Nutrient Wine or Creosote (Nelson & 
Baker), Steam's Wine of Cod Liver Oil, and some prepara- 
tion of Beef, Iron and Wine. Also in giving atropia or bella- 
donna, the fact that they lessen the secretion of the kidneys 
should not be forgotten, especially in those cases in which 
there is considerable decreased urination already. 

Arsenic. Arsenic should be given in all forms of slow 
fevers. The preparation I prefer is that of Fowler's Solution. 
The only contraindication is that of an intensely irritable 
stomach, so much so, in fact, that nothing is retained in the 
stomach. 

Iron. Iron in some form is indicated in all forms of 
anaemia and during all forms of intermittent fevers. But 
iron should not usually be given in any forms of fevers ex- 
cept hsemoglobinuria and erysipelas. However, the tincture 
of iron is the only form of iron to be given in the diseases 
named; but syrup of iodide of iron or acetate of iron is in- 
dicated in some forms of wasting fevers where the stomach 
is weak and debilitated. Iron in any form is contraindicated 
in intensely irritated stomachs. 

Spirits of Nitrous Ether. Sweet Spirits of Nitre may be 
given in all acute inflammatory diseases. It lowers the bodily 
temperature, quiets the nervous system, and is a good di- 
uretic. 

Quinine. As a rule quinine may be given during the in- 
termissions of fever. The best time to give quinine is at the 
beginning of the intermission, or near the end of the declining 



Clinical Effect of Some Common Remedies Used, jj 

stage. Quinine may be given in one or two-grain doses as a 
tonic at the crisis or lysis of a disease; and quinine may be 
given in five-grain doses every two hours to prevent a recur- 
rence of fever in pneumonia or slow fevers. But quinine is 
contraindicated in malarial hematura or hemoglobinuria, al- 
buminaria, irritable or inflamed stomach and an irritable pulse. 
Quinine is contraindicated in many cases, individuals having 
the idiosyncrasy of not bearing quinine in any form. In such 
individuals rashes may appear all over the body in some cases. 
The patient may become very restless indeed, or he may be 
affected with tetanus aurium. In all of these cases the bro- 
mide or hydrobromic acid may be given with the form of qui- 
nine given. But if by the use of these remedies the peculiar 
symptoms continue, then quinine should not be given. 

Ammonia and Ipecac. Ammonia and ipecac increase se- 
cretion. The muriate of ammonia is more easily borne by the 
stomach than other forms of ammonia. These remedies are 
very efficient throughout the first two stages of pneumonia, 
but should be given cautiously or not at all during that form 
of pneumonia in which there is already over-secretion. There 
is no known remedy as efficient in the first stage of acute dys- 
entery as ipecac in one-eighth to one-sixteenth m. doses, with 
orange peel and bicarbonate of soda. However, after the first 
96 to 120 hours, bismuth preparations should supplant ipecac. 

Opium. There is no other remedy that will so com- 
pletely control pain and subdue inflammation as opium in some 
form. But it is wholly unnecessary to add but a few words 
here. In any case in which opium is given to subdue pain and 
inflammation in the alimentary canal it is first better to give 
some form of purgative to relieve the canal of any solid sub- 
stances. Then opium may be gradually increased in quan- 
tity until in sufficient amount to control not only the pain, 
but such a course often will control the inflammation, thus 
subduing the fever. So long as the patient is breathing as 
high as eight to ten times to the minute, so long as he sleeps 
naturally, and so long as he may be easily aroused at any time, 
then the patient is doing all right. But even if the patient 
should have all those favorable symptoms, and at the same 
time after forty-eight or seventy-two hours the fever and 



Typhoid and Other Fevers. 



pulse continue to be as high or higher than before, then the 
opium should be omitted, and at the same time some intestinal 
cathartic should be given as indicated, as calomel, sulphate of 
magnesia or phosphate of soda. But opium should rarely 
ever be given in any form of pneumonia, since it lessens 
secretion. 

Medicines that have a soothing effect on inflamed or irri- 
table mucous membranes. Any remedies that quiet vomiting 
always do so by soothing inflamed mucous surfaces of the ali- 
mentary canal. But, in order for such remedies to quiet the 
stomach, it is usually necessary for such remedies not to be 
only pleasant in taste to the patient, but also pleasant in odor. 
For instance, if such a common remedy as peppermint, which 
is pleasant in taste to most patients, should be unpleasant to 
another, then the peppermint often will not allay the irritable 
stomach of that patient. And so it is with other remedies. 
The most common remedies to quiet the stomach are car- 
bolic acid in one-quarter drop doses, peppermint, bismuth 
in one-quarter drop doses, peppermint, cerium oralate, bismuth 
sub-nitrate, burnt bread-crust in water, pulverized charcoal, 
cerium oxalate, and morphia one-quarter with bismuth in 
five-grain doses ; and it is usually the case that a combina- 
tion of these remedies is more efficacious in controlling vom- 
iting or subduing the inflammation than any single remedy. 

Diuretics. As one of the sources of eliminating the poi- 
sons out of the system is through the kidneys, diuretics in 
some form should always be given during the attack of any 
acute inflammatory disease. And since more or less of these 
poisons must pass through the kidneys, it is readily seen that 
a natural sequela to all forms of acute inflammatory fevers 
is more or less acute nephritis. For this reason diuretics to 
prevent inflammation of the kidneys and at the same time 
hasten elimination of the inflamed products are of especial 
importance in all acute diseases. The most common diuretics 
used are sweet spirits of nitre, digitalis, calomel, bicarbonates 
of soda and potassium, acetate of potash, citrate of potash, 
tincture of strophanthus, citrate or bromide of caffeine and 
tincture of veratrum. 



CHAPTER TV. 
slow fevers — Continued. 

Differential diagnosis. Slow fevers somewhat resemble 
acute tuberculosis. In tuberculosis there is a previous history 
of tuberculosis in the family, but in slow fevers there is no 
such history. There is profuse and exhausting sweats and ex- 
haustive incessant coughing in acute phthisis, which is usually 
only hacking in character in slow fevers. In acute phthisis 
the emaciation of the patient is more severe and more marked 
than in slow fevers. 

Slow fevers may closely simulate acute hepititis or acute 
peri-hepatitis. But in hepatitis there is pain in the region of 
the liver, while pain is absent in slow fevers. And in acute 
hepatitis and peri-hepatitis such medicines as aconite, digitalis, 
gelsemium, veratrum and sweet spirits of nitre not only 
seem to have no influence on lowering the pulse rate and 
bodily temperature, but such remedies usually cause an in- 
crease of both the pulse and temperature ; while, on the other 
hand in slow fevers these remedies usually reduce the tem- 
perature and pulse rate. In fact, either hot or cold water usu- 
ally will cause an increase of bodily temperature and pulse 
rate in acute hepatitis or peri-hepatitis, while hot and cold 
water usually lowers the pulse rate and bodily temperature in 
slow fevers. Quinine, during the intermittent stage of hepa- 
titis and peri-hepatitis, has no effect upon the fever even when 
the pulse is slow, while quinine prevents the return of all other 
intermittent forms of slow fever with a slow pulse, as 90 to 
100 with a temperature of 104 or 105. 



(79) 



CHAPTER V. 

CLASSIFICATION OF SLOW FEVERS. 

Slow fevers may be divided according to their severity 
from the mucous membrane within outward through the un- 
derlying tissue, and as a result of such a division every consecu- 
tive underlying tissue from the mucous membrane of the 
intestinal canal from within outward may thus be a separate, 
special type of slow fever. 

Sequela. The inflammation of these separate, special, un- 
derlying layers may extend in a longitudinal direction from the 
intestinal canal toward the oral cavity. Such a longitudinal 
extension of the inflammation usually involves the same kind 
of tissue as the layer in the intestinal canal. And such an 
extension may be designated as the sequela to the different 
types of slow fevers. 

Complications by reflex irritation. By reflex irritation 
the lungs may become involved, setting up typhoid pneumonia. 

Complications by absorption of poison. Complications by 
the absorption of poison may cause acute osteo-myelitis, acute 
uraemia and acute nephritis. 

Classification of slozv fevers. Slow fevers may be divided 
as follows : 

(X) Acute inflammation of the mucous membrane of the 
intestinal canal. 

(Y) Acute inflammation involving the mucous and sub- 
mucous or vascular coat of the intestinal canal. 

(Z) Acute inflammation of the mucous, sub-mucous and 
muscular walls of the intestinal canal. 

(S) Acute inflammation involving the mucous, sub- 
mucous, muscular and serous coat. 

As diseases have become more and more specialized in 
order to more clearly describe and successfully manage such 

(80) 



Classification of Slow Fevers. 8 1 



diseases, it therefore seems necessary to more minutely divide 
the underlying structure of the intestinal canal, since these 
several layers may give certain well defined symptoms. 

It is true that scientists have not yet attained complete 
knowledge of the vaso-motor and sympathetic nervous centre 
involving the area? (X), (Y), (Z) and (S). Therefore, such 
a subdivision is not without error in some respects. But we 
are confident that such a subdivision, from a practical, clinical, 
therapeutic, diagnostic and prognostic standpoint, is a much 
better subdivision than has yet been given for the following 
reasons : ( I ) Such a division is based upon the idea that the 
main underlying cause of these diseases is a faulty vaso-motor 
apparatus, and the result of which may leave suitable soil for 
the thriving of micro-organisms. (2) The division is made 
on the idea that diseases become more severe in character as 
the deeper underlying structures become more deeply involved, 
the inflammation thus extending from the mucous membrane 
within through the outer layers as the diseases progress. (3) 
The sequela of diseases are described on the assumption that 
an inflammation extends in a longitudinal direction, thus in- 
volving similar tissue to that primarily involved, more easily 
than involving tissues of different structures. (4) Acute in- 
flammatory diseases in the intestinal canal are described on the 
theory that complications are caused by reflex irritation and 
absorption of poison of the inflammatory products. (5) Such 
a division has been thus classified on the idea that not only a 
better diagnosis be made, but a better prognosis, since th*3 
remedies acting on the vaso-motor centre may be more intelli- 
gently administered, and that more attention be paid by the 
clinician on the exact action of vaso-motor remedies in dis- 
ease. (6) These diseases are further classified in this way 
on the theory that facial expressions are controlled by the 
sympathetic nervous system presiding in the area of the layers 
of the alimentary canal. (7) These divisions are made on the 
theory that there are certain well-marked symptoms that 
fairly well designate the special layer or layers involved. (8) 
And I further have made such a classification with these 

clearly defined sequela and complications with the idea that 
6 



82 Typhoid and Other Fevers. 

by such minute description of these different types the phy- 
sician, by knowing the exact structure involved, may know 
the severity of the disease, and thus with appropriate vaso- 
motor remedies prevent complications and sequela. 



CHAPTER VI. 

INFLAMMATION OF MUCOUS MEMBRANE OF THE INTESTINAL 

CANAL. 

Morbid anatomy. In inflammation of the mucous mem- 
brane of the intestines there is inflammation of its corium, 
which contains lymphoid tissue with many leucocytes, and a 
rich supply of blood vessels and nerves. The villi or organs 
of absorption are inflamed and thus prevent absorption. The 
valvula conniventes are inflamed ; and the glands in the mucosa, 
intestinal glands, or crypts of Lieuberkuhn, are also involved. 
These intestinal glands secrete intestinal juices and furnish 
some of the mucus. Therefore, as a result of severe inflam- 
mation of these glands, there is lessened secretions of mucous 
and intestinal juices. 

There are two grades of inflammation of the mucous mem- 
brane of the intestinal canal : 

(x') Mild Grade. 

(y') Severe Grade. 

MILD GRADE. 

Morbid anatomy. In this grade the lympoid tissue is in- 
flamed, but the villi are not sufficiently involved to cause com- 
plete absorption. 

Symptoms. The onset is ushered in with a chill or rigor, 
which is more or less rapidly followed by rise of temperature. 
The temperature gradually rises during the day until from 4 
to 8 P. M., when the highest temperature is reached for the day. 
During the exacerbation the temperature may reach 100 to 102 
and pulse 90 to 100, which remains stationary from 12 A. M. to 
2 A. M., when the temperature and pulse rate begin slowly to 
decline; and by 8 A. M. the temperature and pulse rate reach 
their minimum. And then a rigor or rise of temperature re- 
curs. And on every successive day the temperature at the 

(83) 



84 Typhoid and Other Fevers. 



same hour is one to two degrees higher than previous day. 
The temperature within seventy-two to eighty-four hours 
reaches its height, which may be 103V2 to 104. The tongue is 
moist, and covered with a yellowish or yellowish-white fur. 
The expression of the face is good. The thermometer usually 
registers a degree more under the axilla than per mouth. 
And the extremities are usually warm, giving a fair indication 
of the axillary temperature. Constipation is usually present. 

Prognosis. The prognosis is always good. The duration 
of the disease is from three to eight or ten days. 

Treatment — Dietetics. In every case of slow fever the 
patient should be given only fluid diet. Almost any form of 
fluid may be safely given in this grade of disease, as sweet 
skimmed milk, potato soup, tomato or oyster soup, beef soup, 
chicken broths, etc. The patient should drink only boiled 
water throughout his illness in all types of fevers. Bathing 
should always be given by warm, friction baths in all types of 
slow fevers, unless otherwise specified, and should be used 
every four hours during the day, when temperature is higher 
than 103. 

Therapeutic treatment. The patient should be given in 
every case some form of mercurial preparation, as No. 1 as 
directed. No. 1 may be safely given for four or five consecu- 
tive days. Give No. 18 or 17 throughout the patient's illness. 
And No. 11 or 12 may be given so long as the patient has 
fever. It is usually necessary, even in this mild grade of fever, 
to omit calomel as soon as the temperature has fallen to 100. 
After calomel has been given for four or five successive days, 
it may be substituted by No. 19 for two consecutive days as 
directed. And then No. 2 should be given instead of No. 19 
until the temperature drops to 100 or 101, when it should be 
withdrawn. No stimulants of any kind should be given in 
this type of disease, unless the temperature should drop below 
96 per mouth or axilla. In such cases sulphate of strychnia 
1-30 and atropia sulphate 1-150 grs. given every four hours, 
will be sufficient to cause immediate recovery of the patient. 
As soon as the intermittence occurs, quinine may be given 
every two hours. 



Inflammation of Mucous Membrane of Intestinal Canal. 85 

Clinical case Xo. I. On July 8, 1896, at 2 P. M., I was 
called to visit M. A., who had been seized with a rigor at 9 
A. M. on the previous day. His temperature was 103 2-5 and 
pulse 90. His tongue was coated with a yellowish, moist fur. 
The expression of the face was good, the extremities warm, 
and the bowels constipated. He was ordered a rigid, fluid 
diet, and to drink only boiled water: and was ordered to be 
bathed every three or four hours, when temperature was above 
103. At the same time he was given Xo. 1 as directed; and 
Nos. n and 18 were ordered to be given as directed. On the 
following day at 2 P. M. I saw him again. His temperature 
was 104 and pulse 96, and he had a good facial expression. 
His extremities were warm as on the previous day. The 
treatment of the previous day was repeated. (It may be stated 
that calomel should be given as near as possible at the same 
time of day.) Within ninety-six hours after seeing the patient 
his temperature had fallen to normal. Then he was ordered to 
be given Xo. 30 and Beef, Iron and Wine for three days and 
discharged. 

Clinical case A r o. 2. C. II. was seized with a distinct 
rigor on the iSth day of August. i<;Oi. at 9 A. M., and his 
fever having continued throughout the night, I was called to 
see him at 3 P. M. on the following day. At that time his 
temperature was 104 and pulse 100. His tongue was covered 
with a yellowish-white fur. The facial expression and general 
appearance were good, and tfce extremities were warm. He 
was given Xos. 1, 18 and 11 as directed. On the following day 
at 4 P. M. I saw him, and found that his temperature was 104 
and pulse 100. Being satisfied that his temperature had 
reached its height, I repeated the treatment of the previous 
day. And on the succeeding day the temperature at 4 P. M. 
was 103 2-5 and pulse 94. After this treatment was continued 
seventy-two hours longer, the patient was discharged with the 
instructions to take Fowler's Solution in five-drop doses four 
times daily with five-grain doses of quinine four times daily. 
He soon completely recovered. 



86 Typhoid and Other Fevers. 



SEQUELA TO MILD GRADE OF CLASS A. 

X. Inflammation of the columnar epithelial cells of mucous 
membrane of the stomach. 

Symptoms. In addition to the symptoms described in mild 
form of inflammation of mucous membrane of the stomach, 
there are symptoms of a mild form of stomatitis. The tongue 
may be coated with a whitish, or a whitish-red fur. In this 
form there is no perceptible rise in the temperature, but the 
pulse is usually more irritable and accelerated than where only 
the mucous membrane of the intestinal canal is involved. And 
the theory that the inflammation of the mucous membrane of 
the intestinal canal extends along similar structure in a longi- 
tudinal direction is shown by the fact that such irritation in 
the intestinal canal also irritates the pharynx, since hawking 
for a few days usually is a premonitory symptom of existing 
irritation in the layers of the intestinal canal. Therefore, in 
these cases not only is there mild irritation of the mucous mem- 
brane of the stomach, but also the irritation usually extends to 
the pharynx. And a further proof that the primary inflamma- 
tion or irritation is in the intestinal canal, and not in the 
fauces, is the fact that any non-irritating purgative or cathar- 
tic will also relieve the hawking. 

Treatment. In addition to the treatment already described 
on mild inflammation of the mucous membrane of the intesti- 
nal canal, those non-irritating remedies that quiet the stomach 
and thus soothe the irritable, inflamed mucous membrane of the 
stomach should be administered, as listerine, tannic acid, car- 
bolic acid 14 m., boracic acid one to two grains, essence of 
peppermint, cerium oxalate, subnitrate or salicylate of bis- 
muth, sacchrated or lactated pepsin, burnt bread in boiled 
water, glycerine, pulverized charcoal, lime water, or several 
of these remedies combined, as in No. 25. Such a line of treat- 
ment will not only relieve and prevent severe forms of follicu- 
lar stomatitis, but will usually cure the most obstinate case of 
sequela. 

Clinical case No. 3. The eight-year-old child of A. A. was 
taken suddenly ill with a rigor at 8 A. M., on September 8, 



Inflammation of Mucous Membrane of Intestinal Canal. 87 

1903. The temperature by 4 P. M. had risen to 102V2 and 
pulse to 120. Her tongue was covered with a whitish fur and 
had small red papilla the size of a pin head all over the tongue 
and buccal cavity. She had a good facial expression. The 
extremities were warm. Xos. 1, n, 18 and 25 were given as 
directed. Within forty-eight hours her temperature had risen 
to 104 and pulse 136. At this time Xo. 2 was substituted for 
No. 1 and given for forty-eight hours longer. Then Xo. 2 
was omitted, and X"o. 19 was given every four hours with 
No. 12. By this time the temperature had fallen to 100 and 
pulse to 108. And then Xo. 54 was added as directed for 
twenty- four hours, when the temperature was 98 and pulse 80. 
All the remedies were ordered to be omitted except Xo. 18, and 
two-grain doses of coco-quinine were given every three hours 
for four doses. The elevation of the patient's temperature and 
pulse rate did not recur any more. 

Clinical case Xo. 4. Mrs. J. W. f who was pregnant, was 
seized with a distinct rigor on the nth day of November, 
1896, at 10 A. M., and when I first saw her at 4 P. M. her 
temperature was 104 and pulse 100. Her tongue was covered 
with a whitish coat, in which were intermingled numerous 
pin-head sized papillae, and these papillae were found through- 
out the inner side of the whole buccal cavity. Treatment 
similar to that of Case Xo. 3 was administered. And within 
ninety-six hours the patient's temperature and pulse were nor- 
mal, without any threatened abortion ; and, furthermore, qui- 
nine had been given to prevent the recurrence of the fever. 
And as a result of the treatment there was no return of the 
fever. 

b. SEVERE GRADE OE INFLAMMATION OF MUCOUS MEMBRANE IN 
THE INTESTINAL CANAL. 

Morbid anatomy. In the severe grade of inflammation 
the villi are especially involved, and the deeper layers of the 
mucous coats are involved. 



Typhoid and Other Fevers. 



DIFFERENTIAL DIAGNOSIS BETWEEN THE MILD AND SEVERE 

GRADES OF INFLAMMATION OF THE MUCOUS MEMBRANE 

LINING THE INTESTINAL CANAL. 

The temperature in the mild grade is never above 104, 
and pulse never higher than 112, while in the severe grade 
the temperature may be 104I/0 and pulse 124. And the tongue 
is usually moist in the mild grade, but intensely dry in the 
severe stage on account of the involvement of the villi in the 
mucous membrane of the intestines. The tongue in the severe 
grade usually assumes a more reddish or whitish-yellow color, 
and is more narrow than in the milder type. And calomel more 
easily causes an irritable and accelerated pulse in the severe 
than in the mild grade of this disease. 

Symptoms. The onset is usually ushered in with a rigor, 
cold, or a hot stage, which is followed by a. more or less rapid 
rise of bodily temperature ; and the exacerbation is reached by 
4 to 5 P. M., when the temperature and pulse rate usually re- 
main stationary until from 8 P. M. to 2 A. M. At that hour 
the temperature usually drops gradually until the lowest tem- 
perature during the twenty-four hours is reached. Then soon 
the temperature again slowly rises as on previous day. In the 
majority of cases the temperature rises in this step-ladder-like 
process for from two to five days, when the highest temper- 
ature and pulse rate are reached that will occur throughout the 
illness. Then the stationary or second stage occurs. During 
the stationary period the temperature usually remains near 
the same level throughout the twenty-four hours, and the sta- 
tionary period is usually about the same length of time or 
shorter than the first stage. Then the stage of decline takes 
place; at this time the temperature declines gradually, or fluc- 
tuates for the same length of time or shorter than the other 
two stages, until normal temperature and pulse rate are 
reached. During the exacerbation the temperature may 
reach 104% and pulse 124. If at any time the temperature 
should rise higher than during the first four or five days, then 
such an increased rise of temperature is due to errors in diet, 



Inflammation of Mucous Membrane of Intestinal Canal. 89 

medicines acting as irritants, or to sequela or complications, 
but not to the disease itself. 

How to determine the prognosis in these diseases. The 
prognosis as to mortality is always good ; but the duration of 
the disease may be from twenty-four to forty-eight hours 
longer than in the milder grade, usually being from four to 
ten or twelve days. And in order to better determine just how 
the patient is doing it is necessary to see the patient at as near 
the same hour every day as possible ; for in this way not only 
are the purgatives given near the same hour every successive 
day, but the temperature, pulse rate and general aspect of the 
patient may be better compared than if the physician visits 
the patient irregularly. It is probably unnecessary to say that 
the patient's temperature should be taken and recorded by the 
one in attendance every two or three hours; and, if a nurse is 
in attendance, the pulse should be counted and recorded also. 
And so in this way the physician may more easily find the 
cause of any abnormal variations in the temperature or pulse 
rate. Another favorable indication during the stationary 
stage that the declining stage is about to supervene, is the fact 
that though the temperature and pulse rate are no lower, 
nevertheless the skin appears hotter than at the same hour on 
the preceding day. For this condition plainly shows that 
equilibrium is being established ; or, in other words, the tem- 
perature is coming to the surface, which is always a favorable 
sign. Another favorable sign that shows that the inflammati in 
of the villi of the intestines is subsiding is the increased 
moisture of the tongue and buccal cavity ; and another favor- 
able sign is the change of the coat of the tongue from a red- 
dish, reddish-white, or yellowish-white, to a distinct yellowish 
moist fur ; for when such change occurs the temperature will 
soon begin to decline. But after the first four or five days 
an unfavorable sign is increased dryness of the tongue and 
buccal cavity, if not influenced by drugs as atropia, which in 
such cases the pulse will not be more irritable and accelerated 
and temperature will not be increased, with increased temper- 
ature and accelerated pulse as compared to the same hour on 
the previous day. ^'hen such symptoms as just described 



90 Typhoid and Other Fevers. 

arise, it is due to sequela, complications, errors in diet or 
drinking water, or to some of the medicines acting as irritants. 
And if the cause is not corrected continued rise of temperature 
and pulse rate will supervene, until mucous discharges, bloody 
dysenteric discharges, and even hemorrhage will take place. 

Treatment. Treatment similar to the mild grade may be 
administered, but greater precaution should be taken in using 
calomel too long, which precaution has already been referred 
to. But calomel cautiously given is indicated in these cases, 
for it increases the intestinal secretions, and causes an in- 
creased flow of bile, which seems to have a soothing, aseptic 
and antiseptic influence on the inflamed mucous membrane. 
However, if the pulse becomes more irritable, inflamed and 
accelerated, and the temperature becomes increased when com- 
pared to the same hour on the previous day, calomel should be 
omitted. In such cases, if only three or four days have 
elapsed since the patient became ill, ipecac combined with other 
remedies, as in No. 38, may be given, in order to act as an anti- 
septic, cathartic, and to cause increased secretion. Or No. 55 
may be substituted for No. 38 in these cases. But if these 
remedies fail to prevent the increased irritability, inflammation 
and accelerated pulse rate as compared to the same hour on 
preceding day, they should be substituted by Nos. 19, 22, 23 
or 24, being governed by the severity of the case ; for when 
not severe No. 19 may be given, and when more severe, 
as when hemorrhage is the more nearly being about to oc- 
cur, then No. 22, 23 or 24 may be administered. As has 
been stated, a threatened hemorrhage may be diagnosed 
even twenty-four to forty-eight hours before a sudden 
drop of temperature; these diagnostic symptoms are an 
irritable, accelerated and sclerosed pulse, with more or less 
elevated temperature when compared to the same hour 
as previous day. And after giving these remedies for twenty- 
four to seventy-two hours, calomel, in the form of No. 2, usu- 
ally may be safely administered for two or three days, when 
the temperature usually falls to normal. But if the temper- 
ature is not slowly declining by that time, it is then much 
safer to place the patient upon No. 19 22, 23, 24 or 27, when 



Inflammation of Mucous Membrane of Intestinal Canal. 91 

the temperature will usually fall to normal within twelve days 
from the time of the physician's first visit. But if this should 
not be the case, then No. 25 will bring the temperature and 
pulse rate down to normal within forty-eight hours. Now, in 
some of these cases, the bowels tend to move too frequent 
during the last stage of the disease; in such cases even Xo. 
55 should be used very sparingly, and such remedies as Xo. 
19 when fever, or 19 without salol when no fever, the salol 
being substituted by listerine or carbolic acid in one-eighth 
to one-fourth minim doses, or some other antiseptic that does 
not act in any way as a depressant. In this way the tempera- 
ture and pulse rate will fall to normal within fourteen days. 

Clinical case No. 5. On September 4, 1903, at 10 A. M., 
Mrs. T. C. was taken with a cold stage that was soon followed 
by the exacerbationary stage. During this stage the temperature 
by 4 P. M. was 103 and pulse 90. Then this stationary period 
continued till 12 M., when the declining stage supervened. 
The temperature reached the lowest at 6 A. M., when it was 
101. This low stage continued until 9 A. M., when the cold 
stage recurred, followed by rise of fever in step-ladder-like fash- 
ion as on the previous day. The temperature at 4 P. M. was 104 
and pulse 96. The declining stage began at 2 A. M. and con- 
tinued until 6 A. M., when it was 102 and pulse 90. The tem- 
perature and pulse rate reached their highest at 5 P. M., when 
the temperature was 104 2-5 and pulse 106. The temperature 
and pulse rate remained about the same until September 9th, 
at 4 P. M., when I found her temperature 104 3-5 and pulse 
112. But the favorable symptoms were the returning moisture 
of the tongue and buccal cavity, the change of the coat of the 
tongue from a whitish fur to a moist, yellowish coat, the in- 
creased warmth of extremities over the last two or three pre- 
ceding days without perceptible elevation of temperature, and 
the moisture in the palms of the hands. These symptoms just 
described led me to inform the friends of the patient that the 
temperature and pulse would soon begin to fall. And on Sep- 
tember 10th, at 4 P. M., her temperature was 103 and pulse 90. 
\Yithin forty-eight hours her temperature had fallen to 
normal. 



92 Typhoid and Other Fevers. 

Treatment. She was given as directed Nos. I, 17 and 11 
for forty-eight hours. At this time No. 38 was added for 
forty-eight hours longer, when No. 1 was discontinued. On 
the following day, as her extremities had become warmer with- 
out any rise of the bodily temperature and pulse rate, she was 
again placed upon No. 1 for forty-eight hours longer. And 
then Nos. 1 and 38 were discontinued. On September 12th, 
her temperature and pulse rate having fallen to normal, she 
was ordered to continue only No. 17, and also take No. 60, and 
precautioned not to begin using solid diet for forty-eight hours. 
She made a rapid recovery. 

Clinical case No. 6. T. H. was seized with a slight rigor 
at n A. M., on November 4, 1896. There was the usual step- 
ladder-like ascent of the temperature until, on November 7th, 
at 6 P. M., the maximum of the fever was reached. At this 
time the temperature was 104 3-5 and pulse 112. His tongue 
was whitish and narrow-pointed. He complained of continual 
dryness of the mouth and throat. He had been hawking for 
some weeks before the appearance of the fever. The temper- 
ature remained stationary until 6 P. M., when, though his 
temperature wa,s 104 2-5 and pulse 116, his extremities, how- 
ever, were much warmer than on the preceding day. I further 
noticed that the palms of the hands were moister, the tongue 
was moister and covered with a yellowish fur, and the buccal 
cavity was much moister. From these sysmtoms alone I in- 
formed the family that the temperature would begin to decline 
within forty-eight hours. On the following day at 6 P. M. his 
temperature was 104 and pulse 112, but the skin seemed 
warmer than on the previous day ; and on the following day at 
6.30 P. M. his temperature had fallen to 103 and pulse to 104. 
Within seventy-two hours longer his temperature and pulse 
had fallen to normal. On that night at 2 A. M. the temperature 
had fallen to 96 and the pulse to 64. The family, becoming 
alarmed at the temperature and pulse being below normal, be- 
gan to give large doses of whiskey too freely. As a result of 
over-stimulation the temperature rose gradually, until at 12 A. 
M. the temperature was 103 and pulse 108. I informed the 
family that the stimulation alone had caused the recurrence of 



Inflammation of Mucous Membrane of Intestinal Canal. 93 

the fever. And as a result of the fever the temperature and pulse 
did not fall to normal again until forty-eight hours later. 
During that night at 6 A. M. the pulse had again fallen to be- 
low normal, 60, and the temperature to 96. But no stimulation 
of any kind was allowed, except quinine in two-grain doses 
every three hours. The temperature and pulse rate did not 
rise above normal any more. And the patient was discharged 
and ordered to take No. 60 for forty-eight hours, when a 
solid diet was given. 

Sequela to severe type. In this type the common sequela 
is the extension of the inflammation along the deeper layer of 
the mucous membrane of the stomach to the pharynx. The 
tongue, which is dry, has a whitish or a whitish-red coat, and 
the patient constantly hawks. He has a good facial expres- 
sion. The pharynx looks intensely dry and shining in char- 
acter. On the side of the tongue and inner buccal cavity 
papillae and ulcers may be found. The stomach may be so 
irritable in some cases that it win retain nothing. The pa- 
tient is seized with a distinct rigor, cold or hot stage, which 
is followed by the exacerbation period, which reaches its 
maximum by 4 to 6 P. M. Then the stationary stage oc- 
curs, continuing from 4 to 6 P. M. to from 12 P. M. to 2 A. M. 
And at the end of the stationary stage the declining or third 
stage begins, reaching its lowest temperature at from 4 to 8 
A. M. And soon the recurrence of the onset recurs in step- 
ladder-like fashion. During the first four or five days the 
temperature and pulse rate will have reached their acme ; and 
so by 4 to 6 P. M. the temperature may reach 105 and pulse 
130 or 132. The expression of the face is good throughout 
this type of the disease. The extremities at this time usually 
appear warmer without elevation of temperature and pulse 
rate, and moisture of tongue, buccal cavity and inner side of 
the palms of the hands are usually present at this time. And 
within forty-height hours the declining stage of the disease 
begins. And within four or five days after the beginning of 
the declining stage normal temperature and pulse rate take 
place. 

Treatment. The patient should be given Nos. 1, 11, 18 



94 Typhoid and Other Fevers. 

and 25 throughout the first stage of the fever. Then, if the 
pulse and temperature continue to rise after the first four or 
five days, No. 1 should be substituted by No. 19, 20, 22, 23, 
24 or 27. 

And one of these two above formulas may be given for 
twenty-four to seventy-two hours, when the temperature will 
have become stationary or declining; at this stage, then, No. 2 
may be substituted for one of the non-irritants given. Usually 
the temperature will have begun to decline within forty-eight 
hours after beginning the last remedies ; but if not, then add No. 
38 or 55 for forty-eight hours. In all these cases enemas and 
friction baths, as already described, may be given every three 
or four hours. The precautions already given concerning 
calomel should be used in this type of disease. And due cau- 
tion should also be used in not giving purgatives after the 
temperature has fallen to 100 or 101, and it should be borne in 
mind that in these cases the temperature and pulse may sud- 
denly without warning drop below normal. In such cases, if 
the patient appears to be in a collapsed condition, stimulants, as 
alcohol in teaspoonful doses, strychnia sulphate 1-30 and atro- 
pia 1-150 gr. every three hours, may be administered until the 
temperature and pulse rate rise to normal, when these stimu- 
lants should be lessened. In this way the disease is soon 
brought to a successful termination. 

Clinical case A?o. 7. On the 9th day of October, 1897, at 
11 A. M., J. M. was seized with a severe rigor, followed by a 
rapid rise of temperature and pulse rate. By 4 P. M. his tem- 
perature was 105 and pulse rate 128. His tongue was coated 
with a light reddish fur, intermingled with numerous pinhead- 
sized papillae. At the same time the tongue and buccal cavity 
were intensely congested, being covered with small crescent- 
shaped ulcers. At the same time the tongue and buccal cavity 
were intensely dry, and he complained of intense dryness of 
the throat. The face was red, but he had a good facial ex- 
pression and good general appearance. The extremities were 
even warmer than the internal fever indicated. He was given 
for four conscutive days Nos. 1, 11, 18 and 25. And during 
all this time his temperature and pulse rate did not rise but 



Inflammation of Mucous Membrane of Intestinal Canal. 95 

slightly above that of the first day. And Oct. 13th, at 5 P. 
M., his temperature was 105 1-5 and pulse, which was irrita- 
ble, was 134. At this time Xo. 1 was substituted for two 
days by No. 19, when his temperature at 5 P. M. was 104 
and pulse 120. Then Xo. 2 was substituted forty-eight hours 
for No. 19, when the temperature was 103 and pulse 108. 
For forty-eight hours longer these remedies were continued, 
when the temperature and pulse rate were normal. On 
that night his temperature and pulse rate dropped much 
below normal ; but he made rapid recovery without any other 
medicine than three-grain doses of quinine every four hours 
and No. 18 as directed. 

Clinical case No. 8. T. H., two years old, on September 
14th, at 10 A. M., was seized with a cold stage, which was 
soon followed by the exacerbation stage. During this stage 
the temperature rose to 104 2-5 and pulse 140. The tempera- 
ture continued at this height until 2 A. M., when the tempera- 
ture and pulse rate gradually declined until 8 A. M. the fol- 
lowing day; at this time the temperature had fallen to 102 2-5 
and pulse 120. Then a recurrence of the exacerbation stage 
took place, and at 6 P. M. its temperature was 105 and pulse 
144. The stationary and declining stage recurred near the 
same hour as on the previous day. However, the temperature 
and pulse rate did not rise higher than this on any succeeding 
day. The tongue was coated with a whitish fur, and the inner 
side of the whole buccal cavity was harsh, dry and covered 
with intensely red pin-sized papillae. On Xovember 19th, at 
5 P. M., its temperature registered 105 and pulse was 148. 
The tongue and lips by this time were cracked and bleeding. 
And its extremities seemed somewhat cooler than the tempera- 
ture indicated. 

Treatment. The infant was given for five consecutive 
days No. 1 in one-half-size doses, No. 11 in ten-drop doses, 
No. 18 in twelve-drop doses, and No. 25 in twenty-drop doses 
for the same length of time. At that time the little patient 
not having seemed to be doing as well as desired, Nos. 55 and 
38 were substituted for No. 1. This treatment was continued 
for forty-eight hours longer, when the temperature was 104 



g6 Typhoid and Other Fevers. 

and pulse 130 at 5 P. M. At this time the skin had become 
apparently warmer and secretion had increased considerably. 
And this treatment was continued forty-eight hours longer, 
when its temperature had fallen to 101 and pulse 120. Then 
only Nos. 18 and 25 were continued for forty-eight hours, 
when the temperature and pulse rate were normal. Then 
only No. 18 was continued, and coco-quinine in two-grain 
doses was given every two hours until six doses were given. 
The little patient was soon all right. 



CHAPTER VII. 

INFLAMMATION OF THE VASCULAR, SUB-MUCOUS OR AREOLAR 
COAT OF INTESTINAL CANAL. 

Morbid anatomy. In the meshes of this coat the net- 
work of blood vessels, lymphatics, and nerves are more or less 
inflamed. 

There are two grades. 
(x') Mild Grade. 
(y') Severe Grade. 

X f . MILD GRADE. 

Symptoms. The tongue is beef-red, narrow and pointed, 
being the so-called characteristic typhoid tongue. The 
expression of the face is not usually so good as in the 
grades already described, but occasionally in this form the 
expression may be fairly good. The temperature per mouth 
is usually one or two degrees higher than per axilla. The 
temperature and pulse rate reach their height within Ave 
days after onset, when treated properly. The temperature is 
usually much higher in proportion than the pulse rate in this 
type of acute inflammatory diseases, but the temperature and 
pulse rate rise and fall together in the same ratio with each 
other. And this fact usually is a favorable indication. 

Rose-colored spots may be present, but the larger propor- 
tion of skin eruptions in fever are due to the continued irrita- 
tion of the stomach ; and, therefore, since roseola-eruptions 
occur from the 8th or ioth day in typhoid, if aborted early be- 
fore the stomach is sufficiently irritated to cause skin eruptions, 
these eruptions do not then occur. Hemorrhage of the bowels 
may occur if not properly managed ; also acute dysentery may 
result from improper management of the case. After the fifth 
day the stationary stage is then reached. During this stage 

(97) 



98 Typhoid and Other Fevers. 

the temperature and pulse usually remain near the same as at 
the same hour on the preceding day; or, in many cases, the 
pulse and temperature remain near the same throughout this 
stage. This stage continues four or five days, when the third 
or declining stage begins, if properly treated. During the de- 
clining stage the temperature begins to decline, until within 
three or four days the temperature has fallen to normal. The 
patient throughout the fever may not complain of any pain. 
In many cases the patient seems apparently well. 

Differential diagnosis. The main diagnostic feature of 
this type of acute inflammatory diseases of the intestinal canal 
is the typhoid tongue. 

Prognosis. The prognosis is always good, and may be 
aborted within fourteen days. 

Treatment. Give No. 1 for three consecutive days; Nos. 
18 and 11 should be given as directed during the fever. At 
the end of three days, if the pulse has become irritable, if 
mucous is found in the discharges, if the bowels move with 
great difficulty, or if the bowels move too freely, then omit 
calomel for forty-eight hours and counteract the irritation by 
giving No. 19. Within seventy-two or ninety-six hours after 
beginning No. 19, if the irritation has been controlled, then 
substitute No. 2 for No. 19. This treatment, with Nos. 11 and 
18, may be given for seventy-two hours. At the end of this 
time the temperature and pulse rate usually have fallen to 
normal. 

Now, there is one special characteristic of the condition 
of the tongue in this type of fever to which I desire to call 
especial attention, and that is the fact that a typhoid tongue 
simply signifies a deep inflammation in the intestinal canal, 
and that a typhoid tongue is usually changed to a yellowish 
coat within four to eight days by the daily use of calomel ; and 
then, too, that when the tongue becomes covered with a yel- 
lowish coat it signifies that the temperature and pulse rate 
will soon begin to decline. 

Clinical case No. 9. On November 7th, at 2 P. M., Mrs. 
P. R. was seized with a distinct rigor, followed by more or less 
sudden rise of temperature. The temperature remained at 



Inflammation of Vascular, etc., Intestinal Canal. 99 

its height until after midnight, when the temperature began to 
fall. The temperature reached its lowest about 8 A. M., and 
then the temperature would begin to rise. These three stages 
would recur near the same hour on every successive day until 
November nth, at 4 P. M., I first saw her. Her temperature 
was 105 and pulse no, and facial expression and general ap- 
pearance good. The tongue was intensely red and narrow- 
pointed, the typhoid tongue being present at this time. The 
whole inner buccal cavity was dry and shining, and bowels 
were constipated; and Xos. I, II and 18 were given for three 
consecutive days as directed. Then her temperature was 
105 2-5, pulse 118 and irritable, and her tongue was raw beef 
colored; No. 19 was substituted for No. 1. No. 25 was added, 
and these remedies were continued for forty-eight hours. 
when the temperature was 105 and pulse, which was not so 
irritable, was 114. Then No. 2 was substituted for No. 19. 
On November 18th her temperature was 105 and pnl<e no, 
and her tongue had become coated with a yellowish coat, her 
inner buccal cavity and tongue at the same time being moist. 
As the change of the coating of the tongue to a yellowish 
color and increased secretion indicated that the end of the 
second stage was reached, I informed the family that the tem- 
perature would soon begin to fall. The same treatment was 
continued for forty-eight hours, when the temperature was 
ioi and pulse 100; and as the pulse seemed quiet and non- 
irritated No. 2 was continued twenty-four hours longer, at 
which time the temperature and pulse were normal. She was 
discharged, with orders to take Nos. 25 and 18 as directed, 
and was ordered to take Fowler's Solution in four-drop dose- 
every four hours, with Steam's Wine of Cod Liver Oil in 
tablespoonful doses. 

Clinical case Xo. 10. J. A. F., aged nineteen, was seized 
with a severe rigor on the 17th day of August, 1897. which 
was followed by rapid rise of temperature. At 5 P. M. his 
temperature was 105 and pulse 120, but he had a good facial 
expression and good general appearance. He had the typhoid 
tongue, with red, narrow T -pointed edges, which was dry and 
shining ; also the inner buccal cavity was dry. Treatment sim- 



ioo Typhoid and Other Fevers. 

ilar to that in the previous case was administered. As a result 
of the abortive treatment the temperature and pulse rate did 
not rise during the acme period. On the 21st, though the tem- 
perature and pulse rate were the same on the 17th, however, 
the pulse being somewhat irritable, No. 2 was substituted for 
No. 1, and the expression not appearing so good, while at the 
same time the face being redder than on any preceding day, 
No. 12 was substituted for No. 11. On August 23d the coat 
on the tongue was yellow, and the secretions in the buccal 
cavity were considerably increased. This treatment was con- 
tinued for forty-eight hours, when the temperature had fallen 
to 102 and pulse to 104. And after the same line of treatment 
was continued for two more days the temperature and pulse 
rate had fallen to normal. He was discharged with directions 
to take medicines similar to case No. 9. 

y'. SEVERE GRADE. 

Symptoms. The patient is seized with a distinct rigor or * 
cold stage, which is followed by a more or less rapid rise of 
temperature, followed by the stationary and declining stages 
as in the milder grade. The tongue has the appearance of raw 
beef, being narrow-pointed and intensely red around the edges ; 
and the tongue and inner buccal cavity are usually very dry. 
The patient usually has a general, bad appearance and a bad ex- 
pression of the face, which is usually of a diffused reddish 
character ; and this diffused redness always extends along both 
sides of the neck. In those cases in which the disease is pro- 
gressing unfavorably the pulse will become irritable, more 
accelerated and more inflamed. 

Prognosis. The mortality in this grade depends largely 
upon the general management and treatment of the patient. 
The mortality in my own personal experience in this type has 
been only one case since January, 1897. But I shall describe in 
this chapter three cases treated before 1897. Of these cases 
two died. The duration of the disease is longer than fourteen 
days in 3 or 4 per cent of the cases. 

Treatment. Begin with Nos. 1, 18 and 11 as in the mild 



Inflammation of Vascular, etc., Intestinal Canal. 101 

type. This treatment may be safely given for three or four 
days. After seventy-two hours have elapsed since giving cal- 
omel great attention should be paid to the condition of the 
pulse. For if the pulse is becoming, on every successive day, 
more irritable, inflamed and accelerated or sclerotic, calomel 
at this time should be omitted for twenty-four to forty-eight 
hours. And if there is salivation, mucous, or bloody dysen- 
teric discharges, which indicate a threatened hemorrhage, then 
calomel is contraindicated; or if there is too frequent dis- 
charge, calomel should be withdrawn until the bowels are 
under perfect control. At the end of seventy-two to ninety- 
six hours, if any of these conditions should occur, then Xo. 19, 
20, 23 or 24, according to the severity of the case, may be ad- 
ministered. Usually within seventy-two to ninety-six hours 
calomel in some form may be given again. Then give Xo. 2 in 
full or half-size doses as directed for twenty-four to ninety- 
six hours until contraindicated. If at any time the physician 
fears doing harm in continuing any, longer than three days in 
succession, a supportive plan of treatment should be given, as 
No. 19, 20, 22, 23 or 24; and also No. 25 may be added for 
seventy-two to one hundred and twenty hours ; and then Xo. 5 
in one-third-size doses or X T o. 55 may be given as directed. 
And after ten days have elapsed strychnia sulphate 1-30 to 1-60 
and atropia sulphate 1-150 to 1-200 grain doses may also be 
added every three or four hours. Warm soda solutions may be 
used for friction baths every two to four hours, in order to 
lower the bodily temperature and also in order to improve the 
tone of the internal and peripheral blood vessels. In this way 
the temperature and pulse rate will be brought to normal 
within three to fourteen days. 

I shall relate the history and treatment of the last two 
fatal cases of this type treated by me, which took place prior 
to 1897. Now, the close observation of these two cases gave 
me valuable clinical experience, for I clearly perceived that 
the hemorrhages of the bowels were preceded by irritability 
and later an inflamed and sclerosed pulse ; for these symptoms 
occurred many hours before hemorrhage of the bowels took 
place. 



102 Typhoid and Other Fevers. 

Clinical case No. n. On the 6th day of January, 1896, 
at 8 A. M., J. D. was seized with a distinct rigor, followed by 
the exacerbation, stationary and declining stages. He treated 
himself for four consecutive days with four to six large doses 
of calomel, and during this time he labored, sitting up with 
his sick wife during the day and night. On January 10th I 
first saw him. He had the typhoid tongue, constant dryness 
of the fauces and inner buccal cavity; his face and neck were 
of a diffused, bluish-red character, and his facial expression 
and general appearance were bad. His temperature at this 
time was 103 2-5 and pulse 116. Without fully realizing 
that the patient not only had taken for four consecutive days 
four to six large doses of calomel, but also had wearied him- 
self by his constant attendance on his wife day and night, and, 
furthermore, not realizing that the patient had failed to coun- 
teract the evil effects of calomel by using such as Nos. 11, 18 
and salol, I unwisely continued the calomel at a time when it 
was wholly contraindicated. I gave the patient the following 
treatment: No. 3 as directed and No. 10. On the following 
day at 4 P. M. I saw the patient for the second time. His 
temperature was 104 and pulse 120, and the other general con- 
ditions of the patient were recorded in my diary in these 
words: "I do not like the expression of his face, for he has 
a frowning, disturbed look, and his face is pale and anxious. 
And in addition to this he has a peculiar kind of pulse, which 
I had never detected before, except in the aged."* Unfortu- 
nately not knowing at that time that such a pulse, which I 
now designate as irritable, inflamed and sclerosed pulse, con- 
traindicated calomel, I continued No. 3 for twenty-four hours 
longer, when I wrote in my diary these words : "The tempera- 
ture is 105, and a hard, peculiar pulse that is 132; and the 
facial expression is worse than previous day and very pale. I 
don't like his general appearance." At 5 A. M. on the follow- 
ing day I was called in haste to see him, and found his tem- 
perature was 101 1-5 and pulse 130. He had the same bad 
facial expression as on the previous day; and furthermore 



* Such a pulse, I have detected since as being a positive premonitory symptom 
preceding hemorrhage. 



Inflammation of Vascular, etc., Intestinal Canal. 103 

hsemetemesis had occurred, he having vomited a quart and a 
half of blood. He was given every two hours No. 24, which 
controlled the hemorrhage and checked the bowels, but he died 
a week later. 

Now, the fallen temperature that had dropped so suddenly 
was a warning of the hemorrhage, but such a warning usually 
appears too late to be of any advantage to the physician. And 
there is little doubt but that a sudden drop of temperature in 
such cases indicates that hemorrhage has already occurred. 
No doubt but that calomel will, if continued too long, cause 
an irritable, quick and sclerosed pulse. And so calomel in 
such cases are contraindicated. 

Clinical case No. 12. Then I never had another hemor- 
rhage until May 14, 1896. A. W. was taken with a cold stage 
at 11 A. M., which was rapidly followed by the exacerbation, 
second and third stage. The typhoid tongue, with dry fauces 
and inner buccal cavity and diffused face and red neck were 
similar to case No. 11. I saw him on the fourth day. His 
temperature was 105 2-5 and pulse "124. I gave him Nos. 3, 18 
and 11 for five consecutive days. After the sixth day I placed 
him on Nos. I, II and 18 for four consecutive days. On the 
following day I detected that peculiar pulse as described in the 
previous case; his temperature was 105 and pulse 132, and his 
face and neck had the same diffused redness as on the day I 
first saw him. As I did not at that time fully know the true 
significance of such a hard, brittle pulse. I unwisely gave No. 
1 as directed for another day. And as a result there was a 
sudden fall of temperature at 3 A. M. the following day, and 
he seemed to be in a dying condition. On my arrival at 7 
A. M. his pulse was 142 and temperature 100. Fully realizing 
that internal hemorrhage had occurred, he was given No. 24 
every hour for three doses ; and then No. 24 was given every 
two hours. And hemorrhage of the bowels had occurred at 
the time the sudden fall of temperature had taken place, as 
evidenced by the beginning of a large amount of tarry pas- 
sages in his stools at 1 P. M. Although the temperature 
fell for forty-eight hours, it gradually rose again until, on 
June 3, at 1 P. M., his temperature was 103 1-5 and pulse 132; 



104 Typhoid and Other Fevers. 

at that time his face was pale and anxious. I now continued 
him on only supportive remedies. For he was given the fol- 
lowing medicines, namely: Nos. 19, 18, 1.1 and 24; and in 
order to support the system atropia 1-150, nitro-glycerine 
1-200, and sulphate of strychnine were added every four hours. 
Within two weeks he had fully recovered. 

Clinical case No. 13. R. W. was seized with a distinct 
rigor on July 24, 1896, at 9 A. M., and the rigor was followed 
by a rapid rise in temperature. The temperature at 1 P. M. 
was 104 and pulse 120, and the temperature remained about 
104 until 12 P. M., when the temperature and pulse rate gradu- 
ally declined, until at three on the following morning the tem- 
perature was 102 and pulse 100. And at 9 A. M. a recurrence 
of the rigor took place with exacerbation, stationary and de- 
clining stage, as on the previous day. The temperature rose 
in stepladder fashion for four successive days ; at this time 
the temperature was 105 4-5 and pulse 138; and to make these 
conditions worse the patient refused to go to bed. The dry 
typhoid tongue and dry inner buccal cavity were similar to 
clinical cases Nos. 11 and 12 just described. On July 29, 1896, 
his temperature was 105 2-5 and pulse 142. 

The patient was given the following remedies on the first 
day of his illness, namely, Nos. 3 and 11 as directed for two 
days, when No. 1 was substituted for No. 3 and given with 
No. 11 until July 29th, when I ordered him to go to bed. At 
this time his pulse seemed very irritable indeed. And his face 
on the 29th day of July wore a pale, anxious appearance. 
Then No. 1 was omitted and No. 19 was given for forty-eight 
hours longer. At this time, July 31st, at 4 P. M., bloody dys- 
enteric discharges began to occur in the faeces, and the bowels 
acted three to four times daily. At this time I was called 
away, when Dr. C. was called in; and unfortunately he gave 
the patient a number of large doses of blue mass for four con- 
secutive days, when violent hemorrhage of the bowels occurred. 
On the following day I again saw the patient, and found his 
temperature was 100 3-5 and pulse 140; and he had a very 
pale, anxious expression of the face. I gave the patient Nos. 
24, 11 and 18 as directed; and in addition to this treatment he 



Inflammation of Vascular, etc., Intestinal Canal. 105 

was given ten-grain doses of bismuth subnitrate every two 
hours for ninety-six hours. At this time his temperature was 
102 and pulse 114; and this treatment was continued until 
August 1 2th, at 4 P. M., I found his temperature and pulse 
rate were normal, and his bowels moved only once a day. Then 
I ordered No. 18 in full doses and No. 11 in one-half-size 
doses to be given ; and quinine and Fowler's Solution were 
given with Elixir of Beef, Wine and Iron. But within ninety- 
six hours the patient unwisely began work too early ; and as 
a result of this grave error he was seized with a relapse of the 
fever. At 4 P. M. his temperature was 104 and pulse 140, 
and he was at the same time sweating profusely. His tongue 
was cracked, bleeding and covered by a thick, brown crust. 
He was given Nos. 24 and 11. But on the following day his 
temperature was 104 and pulse 144. In addition to that treat- 
ment above, he was given bismuth every two hours with black- 
berry brandy. But his bowels continued to move twelve to 
fourteen times daily ; then enemas containing tincture of 
opium and starch were given four fimes daily. As his bowels 
continued to move five to ten times daily and he continued to 
sweat profusely, aromatic sulphuric acid in twenty-drop doses, 
atropia sulphate 1-50 grain, and strychnia sulphate 1-30 grain 
were administered every four hours. However, the patient 
died August 27, 1896. 

Criticism of case No. 13. Now I shall write the comment 
as written down by me in my diary concerning this case. "In 
the first place, the patient should have been ordered to remain 
in bed from the very beginning of his illness. (2) The patient 
should not have been given any purgative after the sclerosed 
pulse was found to be present. (3) It was a grave error that 
such large doses of blue mass were given, for the fact that not 
only had he been given purgatives too frequently, as evidenced 
by the pulse, but furthermore he had weakened himself very 
much by refusing to go to bed. And finally the greatest error 
was the fact that he had been allowed to do laborious work 
while suffering with a severe diarrhoea. " 



CHAPTER VIII. 

SEQUELA FOLLOWING INFLAMMATION OF THE VASCULAR LAYER 
OF THE INTESTINES. 

The most common sequela is the extension of the inflam- 
mation of the vascular layer of the intestines, extending to the 
vascular layer of the stomach, pharynx and tonsils. 

Symptoms. In addition to the symptoms already de- 
scribed, the pharynx and tonsils are also involved. In these 
cases false membrane forms very rapidly. And, owing to the 
involvement of the vascular structure in this region, the ad- 
joining lymphatic glands in the region of the tonsils are often 
severely affected. And, in addition to the pharynx and ton- 
sils, follicular stomatitis may also be present. In such cases 
there are seen on the tongue small red pinhead-size follicles, 
and such follicles may cover the whole lining of the inner buc- 
cal cavity. In most cases of follicular tonsilitis there is also in- 
flammation of vascular layer of tonsils and pharynx extending 
along this layer to the vascular layer of the intestines. Now, 
such involvement of the tonsils is often erroneously called 
diphtheria. 

Prognosis. The prognosis in these cases is always good. 

Treatment. The most important point to consider in every 
case of follicular tonsilitis is the prevention of the rapid form- 
ation of false membrane in every case treated. For it has 
been my experience for fifteen years that, if proper treatment 
be given early in these cases, then not only will the intervals 
between the formation of the false membrane be increased, 
but the rapid formation will also be lessened in intensity, and 
often may be aborted altogether. 

In order to lengthen the intervals between the formation 
of the false membrane, and in order to dissolve this membrane, 
Nos. 15% and 25 should be given. And in order to quiet the 
stomach give No. 45 as directed. 

Then these medicines, given in addition to that adminis- 

(106) 



Sequela Following Inflammation of Intestines. 107 

tered in inflammation of the vascular coat of the intestines, 
will cure these cases. 

Clinical case No. 15. Alary C, aged five years, was 
seized with a rigor on October 4, 1898. Her temperature soon 
rose to 104 and pulse to 136. And this temperature did not 
begin to decline until 1 A. M. At 6 A. M. the temperature 
was 102 and pulse 118. By the 8th day of October the tem- 
perature and pulse rate had reached their height ; at that time 
the temperature was 105V- and pulse 156. The tongue was 
typhoid in character, and the whole inner buccal cavity was 
covered with pinhead-sized, reddish follicles ; and small yel- 
lowish-white spots were seen on the tonsils, the tonsils being 
greatly enlarged. No. 1 was given for forty-eight hours, 
when Xo. 55 was given for three days. On October nth false 
membrane formed on the tonsils every ten minutes, and the 
lymphatic glands became greatly enlarged. Xow antitoxin in 
these cases is contraindicated, for the mortality is consider- 
able with the use of antitoxin ; while in those cases where the 
remedies already described have been given, the mortality is 
only one case since 1897. In order to lengthen the intervals 
of the formation of pseudo-membrane, and in order to lessen 
the severity of the disease, No. 25 was given every ten minutes, 
and No. 15^ every hour. Soon Xo. 151.. was given every 
time there was formation of the pseudo-membrane. In this 
way the patient soon recovered. 

Clinical case No. 16. Minnie II., aged live years, was 
taken with a distinct rigor on December 4, 1907; her tempera- 
ture was 104 and pulse 132. The temperature and pulse rate 
continued to rise until December 9, 1907, when her temperature 
was 105 2-5 and pulse 160. At that time small, red follicles 
were seen on the tongue and inner buccal cavity, and the ton- 
sils and pharynx were covered with reddish-white spots. The 
tonsils were greatly enlarged, and there was a formation of 
pseudo-membrane, which formed every fifteen minutes. Nos. 
I, 18 and n were administered as directed; and No. 15% 
every two hours, and No. 25 was given every twenty min- 
utes. Within ten days the patient had entirely recovered. 



CHAPTER IX. 

INFLAMMATION OF THE MUSCULAR LAYER OF THE INTESTINES. 

An inflammation of the mucous membrane of the intestines 
extending to the muscular coat may be called "inflammation of 
the bowels" from the fact that no special structure is involved, 
but rather the mucous membrane : the vascular layer and mus- 
cular coat are involved at the same time. 

INFLAMMATION OF THE BOWELS. 

Symptoms. The patient is seized with a distinct chill, 
rigor or hot stage. The chill is more or less rapidly followed 
by the exacerbation, which reaches its height between 2 P. M. 
and 8 P. M. ; then the stationary stage continues until about 
2 A. M., when the temperature and pulse rate have fallen to 
the lowest. Then soon the onset recurs, followed by the ex- 
acerbation, stationary and declining stage as on the preceding 
day. Within ninety-six to one hundred and twenty hours after 
the onset of the disease the fever has reached its height. At 
this time the temperature may rise from 105% to IQ 6 or 
higher, and the pulse rate may rise to 140 in adults, 150 to 180 
in children or 200 to 220 in infants. The tongue, which is 
dry, is unusually whitish, whitish-red, or a distinct typhoid 
tongue may be present; and in many cases the patient pro.- 
trudes his tongue with the greatest difficulty, the tongue at the 
same time trembling as it is protruded. The patient always 
has a. bad facial expression, and the general aspect of the 
patient is bad. The internal temperature is usually higher 
than the external temperature of the body. In this type of 
slow fever the extremities during the first stage are cold, and 
the face usually is pale and anxious. The pulse usually is 
very rapid in proportion to the temperature, or in rare cases 
the pulse may be slow throughout the disease. The vaso- 
motor and sympathetic nervous centre presiding over this area 

(108) 



Inflammation of Vascular Layer of Intestines. 109 

is shown by the fact that there continually is a period of 
paling and flushing of the face throughout the disease. 
But there is not much zigzag temperature and pulse rate 
so long as only the bowels are affected, for usually the 
temperature and pulse rate rise and fall in stepladder fashion 
with the rise of the day during the first stage. The tempera- 
ture under the axilla is usually one to two degrees higher than 
per mouth. After the first stage the second or stationary 
stage supervenes. The extremities are usually cold ; the ex- 
ternal temperature is usually a degree or two higher than the 
internal temperature. The tongue is typhoid, wide and flabby, 
or brown and dry. The patient's bowels from the very begin- 
ning of the disease is prone to move too easily. The patient 
rarely sleeps well at night. The pulse is very prone to become 
irritable, inflamed or sclerotic. The temperature and pulse 
rate remain near the same throughout the stationary or second 
stage. At the end of the stationary stage the extremities be- 
come warm ; the tongue becomes yellowish-white, or yellowish 
in color and moist ; there is lessened variation between the ex- 
ternal and internal temperature ; in fact, the external tem- 
perature is often a degree higher than the internal tempera- 
ture. All these subjective and objective symptoms clearly in- 
dicate the end of the second and the beginning of the third 
stage. 

Declining or tliird stage. During the declining stage the 
temperature and pulse rate begin to fluctuate to a greater or 
lesser extent, and then gradually decline until the normal tem- 
perature is reached. During the third stage the patient be- 
gins to sleep better, the appetite returns, and the general facial 
expression becomes much better. Now in this type of slow 
fever there is another special sign that should not be forgotten, 
namely, the hot, inflamed condition of the bowels in the hy- 
pogastric region. The bowels in these cases may be hot- 
ter than in any region of the body, or the bowels may be tender 
and more less swollen. 

There are two distinct grades of this type of slow fever: 

(x) Pyretic Type. 

(y) Subnormal Type. 



no Typhoid and Other Fevers. 



(x) PYRETIC TYPE. 

In this form of slow fever, during the exacerbation stage, 
the temperature may rise to 105 or 106 or higher and the 
pulse to 140. 

Treatment. Calomel should be given with extreme cau- 
tion even from the very beginning of the disease. A very 
irritable and sclerosed pulse always contraindicates the use of 
calomel in these cases. In the beginning of this disease, when 
calomel is contraindicated, Nos. 5 or 55 may be given for three 
or four days. At the same time a continued, rapid, irritable, 
sclerosed pulse if long continued contraindicates salts in any 
form. iVfter four or five days have elapsed from the onset 
of the fever, the following indications contraindicate the use 
of calomel: (1) Intense diarrhoea, dysentery, irritable or 
sclerosed pulse, if long continued, contraindicates salts or other 
purgatives in any form. After four or five clays have elapsed 
from the onset of the fever, the following indications contra- 
indicate the use of calomel: (1) Intense diarrhoea, dysentery, 
irritable or sclerosed pulse, a continual daily rise of tempera- 
ture and pulse rate, salivation, or when the temperature falls 
to 100 or below. In all those cases where purgatives are con- 
traindicated Nos. 19, 22, 23, 24 or 27 may be given for forty- 
eight to seventy-two hours, when calomel may be cautiously 
administered. Or if calomel is not given, then No. 5 or 55 
may be given. But all the contraindications of calomel 
must always be closely watched before it is ever admin- 
istered. And the diuretic action of the kidneys should 
always be maintained in order to prevent acute nephritis; 
therefore, when the secretion of urine is below normal No. 
11 may be administered. Friction baths of warm soda 
water solution may be given every two hours in order to 
cause less heat production and more heat dissipation, and 
in order to get nearer to an equilibrium, the vaso-motor 
capillary systems. And in order to assist in better co-ordinat- 
ing the vaso-motor system, vaso-motor remedies as veratrum, 
atropia, nitro-glycerine and digitalis may be given under cer- 
tain well-defined conditions, bearing in mind that any of these 



Inflammation of Vascular Layer of Intestines. in 

remedies must lower bodily temperature and pulse rate if 
they do any good in these cases. Therefore, if they do not 
lower pulse rate and bodily temperature, then they are con- 
traindicated. In addition to these remedies, poultices of some 
kind should always be kept over the hypogastric region. In 
those cases in which there is deficient urination, an onion 
poultice or a peach tree leaf or bark poultice has a distinct 
diuretic effect; and these poultices subdue the inflammation of 
the bowels in the majority of cases. However, if the inflam- 
mation continues to spread, and if the bowels become swollen 
and tender, hot turpentine stupes, iodine and glycerine in equal 
proportions, hot applications, or other soothing applications 
placed over the bowels subdue the inflammation. So long as 
the temperature and pulse rate are not increasing, and so long 
as the irritability of the pulse is being subdued, it is to be dis- 
tinctly remembered that just so long is inflammation of the 
bowels being controlled. In all of these cases treated, Xo. 17, 
18, or some other medicine to aid digestion, should be given. 
The drinking water should always be boiled, and medicine to 
soothe inflammation of the bowel structures should be ad- 
ministered as No. 25. 

Clinical case No. 17. In order to strongly impress the 
reader with the importance of not giving calomel or irritating- 
purgatives in this type of disease, I shall give the history of the 
following case: On the 12th day of September, 1896, Mary S., 
aged eight years, was seized with a distinct rigor, followed 
by slight rise of temperature. The parents gave the child for 
forty-eight hours repeated doses of black draught. On Sep- 
tember 14th, at 4 P. M., I was called to see the child. Her 
temperature was 102 and pulse 112. But she had a fearful, 
agonizing facial expression. Her extremities were cold and 
face very pale. She complained of a severe pain in the hypo- 
gastric region. With all these symptoms she had an irritable 
sclerosed pulse. But, unfortunately, even with all these char- 
acteristic symptoms, I did not grasp the bad, prognostic sig- 
nificance of these well-marked signs on account of their ap- 
pearing so early in the disease. So I unwisely gave her No. 1 
as directed. Hemorrhage of the bowels occurred that night at 



H2 Typhoid and Other Fevers. 

12 P. M. to such an extent that she died at" 6 A. M. Now, this 
case conclusively proved to me that the physiognomy of the 
patient, the irritable sclerosed pulse are all distinct, premoni- 
tory symptoms of a threatened hemorrhage, even if seen as 
early as the third or fourth day after the onset of the disease. 
Clinical case No. 18. On the 5th day of August, 1903, 
J. H., aged eight years, was seized with a distinct hot stage, 
followed by the exacerbation, stationary and declining stage. 
On the following day the onset and the other stage recurred as 
on the preceding clay. The patient from the very beginning had 
a bad, pale, anxious expression; she complained of an intense 
pain in the hypogastric region, and the pulse within forty- 
eight hours was irritable and scleroted. Her temperature at 
that time was 105 and pulse 170. Fully realizing that she was 
threatened with a hemorrhage of the bowels, she was given 
Nos. 25, 23 and 18 in one- third-size doses as directed. And 
No. 11 with salol was given in one-third-size doses. On 
August 10th her temperature was 103 and pulse 120. At this 
time No. 55 was given for forty-eight hours, when her tem- 
perature was 102 and pulse 112. Then she was given No. 
23 in one-third-size doses for two successive days, when her 
temperature and pulse rate had fallen to normal. She made 
a rapid recovery. In this case, as in all other cases, hot fo- 
mentations, as described in case No. 16, were applied. 

(y) SUBNORMAL TYPE OF SLOW FEVER. 

Symptoms. The patient is seized with a chill, distinct 
rigor, a cold or hot stage. This stage is followed by the sub- 
jective symptoms of heat, which continue until near mid- 
night, when the patient complains of feeling cool. There are 
regular periods of paling and flushing of the face during the 
time that he complains of being hot. The expression of the 
face is bad, and he has a general bad appearance. The tongue 
is usually wide and flabby, or it may be typhoid in color and 
it may be protruded with great difficulty, and in many cases 
the tongue from the beginning of the disease is extremely 
irritable and nervous. And so with all these characteristic 



Inflammation of Vascular Layer of Intestines. 113 

symptoms the physician is led to believe that the patient has 
considerable internal fever. But the pulse may not be more 
than 80 or 90, and the fever thermometer usually does not reg- 
ister per mouth more than from 98 to 101 during his subjec- 
tive hot stage. However, the temperature under the axilla 
usually is two or three degrees higher than per mouth. In 
these cases the family should be informed that the patient has 
a subnormal type of slow fever, and that every minute direc- 
tion must be carried out in order to abort this type within ten 
to fourteen days. The patient usually rests badly at night, 
and his bowels are prone to move too easily. 

Prognosis. The prognosis in these case^ is always good, 
when properly managed. 

Treatment. Calomel should always be given with ex- 
treme caution in this type of slow fever. Usually Xo. 2 may 
be given for two or three consecutive days with safety. At 
the same time Nos. 11, 18 and 25 may be given as directed. As 
the secretions are usually checked up, Xo. 44 may be added for 
three or four days; but if the stomach or bowels are tender 
and irritable then Xo. 38 may be substituted for Xo. 48. In 
order to get the vaso-motor system in better condition, friction 
baths of warm soda water solution may be used every three 
or four hours. If the patient does not rest well at night, 
bromidia well diluted in fifteen to thirty-drop doses may be 
given every two or three hours until sleep is produceed. After 
two or three days calomel should be omitted. Then, if the 
bowels are not too loose, Xo. 55 may be given every two or 
three hours. And after forty-eight hours Xo. 19. 22, 23. 24 
or 27 may be given in order to allay any irritation, and in 
order to keep the bowels under perfect control. If the bowels 
should become very loose, then give bismuth in ten-grain 
doses every two hours. For an intestinal antiseptic salol in 
three-grain doses may be given every three or four hours if 
the temperature per mouth is above .98; if not, then omit. 
Hot turpentine stupes on the bowels and cold cloths on the 
head should be used throughout the patient's illness. If the 
patient is getting better, his facial expression will improve, 
his external and internal temperature will become nearer 



H4 Typhoid and Other Fevers. 

together, and his axillary temperature and temperature per 
mouth will register more nearly what his temperature appears 
to be by the touch and general appearance. In this way the 
patient within ten to fourteen days will fully recover. 

Clinical case No. 19. On the 1st day of September, 1907, 
J. S., aged fifty-five, was seized with a cold stage that was 
rapidly followed by apparent rise of bodily temperature. Dr. 

being called in to see him, gave him repeated doses of 

calomel and quinine, but he gradually grew worse, until the 6th 
day of September I saw him for the first time. His face would 
be at one moment intensely pale, while a few moments later 
his face was flushed and anxious. His bowels were tender 
to pressure, and moved from six to eight times daily. The 
tongue was wide, red and nervous when protruded. He 
hadn't rested at night since he had been ill. He complained of 
being intensely warm at times. His pulse was 90 and his tem- 
perature per mouth was 100; but his temperature per axilla 
was 102. He was given Nos. 18, 11, 19 and 25 as directed, 
and warm friction baths of soda in water were ordered every 
four hours. Bismuth in five-grain doses was added every 
four hours. Twenty-drop doses of bromidia, well diluted, 
were ordered to be given every two hours at night to cause 
sleep. Then forty-eight hours later No. 55 every three hours 
was substituted for No. 19. This treatment was continued 
for forty-eight hours, when the patient was discharged. 

Clinical case No. 20. On the first day of September, 1907, 

Mrs. was seized with a slight rigor, which was soon 

followed by an intense vertigo. She had frequent attacks of 
intense paleness and flushings of the face. Her temperature 
per mouth and axilla never registered higher than 99; often 
the temperature was two or three degrees below normal. The 
pulse was from 64 to 78 throughout her illness. She was 
given Nos. 1, 18 and 54 for forty-eight hours; but No. i 
seemed to aggravate her trouble, since her bowels acted slug - 
gishly and her dizziness became worse. Then she was given 
No. 55 for three days, when she completely recovered. 



CHAPTER X. 

SEQUELA TO INFLAMMATION OF THE MUSCULAR COAT OF THE 
I X T E ST] N A L C A N A L . 

(x) Acute Gastritis, 
(y) Diphtheria. 
(z) Membranous Croup. 
(s) Appendicitis. 

(x) ACUTE GASTRITIS. 

Symptoms. In addition to the symptoms already de- 
scribed, inflammation extends to the muscular walls of the 
stomach. In such cases the stomach is usually tender and 
swollen. The pulse is always more accelerated. 

Treatment. In addition to treatment already given, hot 
fomentations may be applied over the epigastric region, and 
greater precautions should be used in giving purgatives. 

(y) DIPHTHERIA. 

Diphtheria shall be described only from a practical, clin- 
ical, prognostic, diagnostic and therapeutic standpoint. 

Now, as I am fully convinced that many micro-organ- 
isms are rather the result of certain diseased structures than 
the cause of the diseased conditions, I am for the same reason 
of the opinion that diptheria may usually be prevented by 
proper remedies. In all the cases of diphtheria there is also 
inflammation of the same structures in the intestinal canals. 
For this reason it is always of primary importance to treat 
the inflamed condition of the structures extending along to the 
intestines as well as the throat itself. Now, if this idea is 
firmly impressed upon the reader's mind, and if he uses as di- 
rected the remedies and plan of treatment laid down at this 
place, then he will have a mortalitv of not more than one-half 

("5)' 



n6 Typhoid and Other Fevers. 

of one per cent. Such a low mortality is certainly much 
lower than the most enthusiastic Antitoxin advocate dares to 
claim. 

Symptoms. The patient is seized with a distinct chill, 
rigor or hot stage, which is rapidly followed by more or less 
rapid rise of the temperature and pulse rate. But it is more 
especially to be noticed that the pulse in diphtheria is more 
greatly accelerated in proportion to the temperature than in 
any other disease. Such a rapid pulse is partly due to the 
highly inflamed condition of the muscular structure extending 
to the intestines and to the absorption into the blood of the 
gases and ptomaines emanating from these internal diseased 
structures. The yellowish or yellowish-white spots on the 
tonsils have been so frequently described as to be only referred 
to in this work; and the same may be said as pertaining to 
the more or less rapid formation of the fibrin or pseudo-mem- 
brane. Suffice it to say that the formation of the false mem- 
brane may be so rapid as to form, in severe cases, as often as 
from every three to five minutes. 

It is true that the scientific world at the present time 
recommends antitoxin in these cases. But on reflection any- 
one must admit that even the mildest cases are recorded when 
giving the mortality in these cases ; and even then the mortality 
is admitted to be considerable. Therefore, Antitoxin is men- 
tioned only to be condemned in these cases. 

Mortality. The mortality even in the severest cases with 
proper treatment is not more than from one to two per cent. 

Preventive treatment. In every case seen, even of the 
mildest form, the physician from the very beginning of the 
disease should treat as if it were a severe type; for if a physi- 
cian can really successfully manage a very severe type of diph- 
theria, then he surely can prevent a mild case from merging 
into a severe type. Then, too, fully realizing the fact that 
there is always an involvement of the muscular walls in the 
intestinal canal, close attention in the management of the in- 
flamed structures in the alimentary canal will very materially 
lessen the mortality in diphtheria. 

Treatment. As soon as called to see a case of diphtheria, 



Sequela to Inflammation of Intestinal Canal. 117 

the family should be quarantined, or at least ordered not to 
admit any children in their home during the attack. A strict 
fluid diet should be ordered; and only boiled drinking water 
should be allowed. In order to prevent the rapid absorption 
in the blood of the poisons, No. 55 may be given in sufficient 
amount to move the bowels three or four times daily. The 
parents should be impressed with the importance of the free 
action of the bowels, since infants and children often swallow 
the highly inflammatory products thrown off from the tonsils. 
Some external application of some kind should be applied op- 
posite the tonsils on the outside ; but extreme care is required 
in applying any remedy to the tonsil itself, for fear of increas- 
ing the irritation and further inflammation of the already 
highly inflamed tonsil. As the tonsils are composed largely of 
muscular tissues, it is evident that salicylates should be used 
in every acute or chronic disease involving the tonsils, and 
other remedies used in acute rheumatism may be administered 
in diseases of the tonsils. And since aconite is a vaso-constric- 
tor, thus driving blood from the tonsils, aconite may be given 
for seventy-two to ninety-six hours, .^fter this time some 
other remedy should be given, as tincture of veratrum viride 
or digitalis. Therefore, in the very beginning of every case 
of affections of the tonsils, Nos. 5 or 55. 15U and 18 may be 
given as directed. In more severe cases Xo. 15V2 may be 
given every hour for twenty-four hours. And in diphtheria, 
in order to dissolve the false membrane, and in order, by its 
antiseptic and soothing effect, to prevent the formation of this 
false membrane, No. 25 should be given as rapidly as the form- 
ation of the pseudo-membrane. So in severe cases No. 25 may 
be given every three to five minutes. Now, by giving No. 
25 as rapidly as referred to above, the intervals between the 
formation of the false membrane will gradually be lengthened. 
So No. 25 should be directed to be given every time the pa- 
tient coughs up the membrane. Equal parts of iodine and gly- 
cerine may be applied externally to the throat, or some other 
applications, as tar poultices, ichthyol, onion poultices, etc., may 
be used. The tonsile should be touched only gently, if at all, 
only with such remedies as tincture of iron and glycerine, or 



n8 Typhoid and Other Fevers. 

tincture of iodine and glycerine; since the too frequent appli- 
cation to the tonsils has a great tendency to irritate the already 
inflamed tonsils, and thus increase the formation of pseudo- 
membranes. 

In treating diphtheria it must be distinctly remembered 
that, so long as the pulse rate and temperature (more espec- 
ially the pulse) are lowered by aconite, this remedy is indi- 
cated. But after forty-eight to ninety-six hours, if the tem- 
perature and pulse rate are not lessened, then Nos. 54, 13 or 11 
may be given. If there is not free action of the kidneys, give 
No. 54 for twenty-four to forty-eight hours. By that time, if 
the pulse and temperature have not been reduced, then give 
No. 11 as directed. In the large majority of cases the disease 
will be controlled by No. i^fe- But if neither 15% nor 54 
has brought the disease under perfect control, such a condi- 
tion is largely due to the inflammatory condition of the intes- 
tines. Then in such cases give Nos. 11 and 55 throughout the 
disease. As the bowels are so easily moved in this disease, 
great caution should always be used in giving purgatives of 
any kind, for fear of losing control of the bowels. On ac- 
count of this danger the bowels, after the third day, should 
never be allowed to move more than three or four times daily. 
The same treatment as used in inflammation of the bowels to 
prevent or cure nephritis should be used in diphtheria. And 
liniments, poultices, iodine and glycerine applications or other 
remedies may be applied on the throat for enlarged, inflamed 
lymphatic glands. And if the nares are involved, No. 61 
may be applied in the nares every two or three hours. If the 
patient does not rest at night, then bromidia in fifteen-drop 
doses may be given every two hours to give rest. In many 
severe cases even one to two-drop doses of carbolic acid every 
two to four hours may be added to the treatment already re- 
ferred to. In many of these cases the patient also has a 
cough. In such cases No. 44 may be given when cough is 
extremely tight. Or in those cases where the cough is too 
loose atrophia sulphate may be given in 1-600 grain doses every 
two or three hours to a child four years old, and younger 
children in proportionate doses. Friction baths in warm or 



Sequela to Inflammation of Intestinal Canal. 119 



cold water with soda may be used. The nurse should be cau- 
tioned to always leave the patient perfectly dry, so as to avoid 
taking more cold. 

Clinical case No. 21. D. C, an infant, aged thirteen 
months, was seized with a severe hot stage on October 4, 1901. 
Within twenty- four hours the temperature rose to 1003-5 an d 
pulse 180. The little patient had a bad facial expression. On 
close examination I observed that both tonsils were greatly en- 
larged and very acutely inflamed, having the distinct diph- 
thcretic spots. Also his tonsils were distinctly prominent by 
external manipulation, and the lymphatic glands were consider- 
ably enlarged. Only fluid diet was given. Nos. 18, 151/, and 
55 were given as directed, and No. 61 was used as directed. 
But within twelve hours the pulse was 220, the temperature 
106, and the false membrane was being expelled with great 
difficulty every twenty minutes. Then No. 15% was given 
every hour, No. 55 every hour, and No. 25 was ordered to be 
given every time the false membrane appeared. An onion 
poultice was retained on the throat, and iodine and glycerine 
were applied every three hours. And warm friction baths 
were ordered to be used every two or three hours. Listerine 
in five-drop doses was given every three hours. Within a 
week the little one had completely recovered. 

Clinical case No. 22. December 1, 1906, R. C, aged two 
years, was taken with a. distinct rigor, followed by rapid rise of 
bodily temperature. A yellowish diphtheritic spot was seen 
on both tonsils, and the lymphatic glands were greatly enlarged. 
The temperature was 105V2 and pulse 178. The little patient 
was given No. 1 every one and a half hours, followed by oil ; 
but his bowels failed to act, and temperature and pulse rate 
continued to rise. So, realizing that calomel was contraindi- 
cated, No. 55 was substituted. No. 15V2 was given every hour 
for seventy-two hours, and No. 18 was given before meals. 
No. 25 in one-half to one teaspoonful doses was directed to be 
given as often as the pseudo-membrane formed. Within 
one hundred and twenty hours the false membrane did not 
form any oftener than every four hours; but the bowels had 
become more inflamed and swollen. Observing that the ac- 



120 Typhoid and Other Fevers. 



tion of the bowels was clay-colored, and that the fever and 
pulse rose when the bowels did not act, the infant was given 
No. 55 every two hours ; and No. 1 1 in one-quarter size doses 
was given every four hours, together with No. 18, before 
meals. She completely recovered within one hundred and 
twenty hours after beginning with Nos. n and 55. Then, in 
order to prevent kidney complications, Basham's Mixture, with 
small doses of No. 11 and elixir of Beef, Iron and Wine, were 
given. 

(z) MEMBRANOUS CROUP. 

This disease will be described only from a. clinical stand- 
point. Membranous croup is merely a diphtheria of the lar- 
ynx instead of the tonsils. In a large majority of cases mem- 
branous croup is due to the extension of the pseudo-membrane 
from the tonsils to the larynx. 

Symptoms. The patient has been ill for a few days, the 
illness being due to inflammation of the tonsils, when he grad- 
ually coughs intensely hoarse. Then later a distinctly croupy 
cough is noticed. High fever with an accelerated pulse rap- 
idly supervenes. The croupy cough grows worse, and the 
pulse and temperature grow more rapid in direct proportion 
to the severity of the disease. The fever and hoarseness do 
not entirely subside at any time throughout the disease. The 
bowels are usually inflamed as much, if not more, in membran- 
ous croup than in diphtheria of the tonsils. In severe cases 
the false membrane may form every two or five minutes; the 
pulse in an infant may rise to 180 to 240, and the temperature 
from 105 to 106 or 106%. 

Differential Diagnosis. Membranous croup may be con- 
founded with false croup by an unobservant physician. False 
croup comes on very suddenly, usually between 11 P. M. and 3 
A. M., while true croup comes 'on more slowly. In false croup 
the patient usually seems apparently well on the morning fol- 
lowing his attack, having normal temperature and pulse rate; 
but in true croup the patient is quite hoarse, and has more or 
less fever, with accelerated pulse. Then in false croup the pa- 
tient usually gives a history of previous attacks, which is not 



Sequela to Inflammation of Intestinal Canal. 121 

the case in true croup. And the very high temperature or ex- 
tremely rapid pulse and the bad facial expression of the little 
patient in true croup will readily differentiate it from false 
croup. 

Treatment. The treatment of membranous croup is 
identical with diphtheria, for, as previously stated, a mem- 
branous croup is nothing more than an extension of the diph- 
theria from the tonsils down into the larynx. In addition to 
the treatment for diphtheria, a croup kettle should be placed 
near the patient, over whom a sheet tent has been placed. In 
the croup kettle should be placed calomel and lime water. The 
steaming of the croup kettle containing lime water and calomel, 
with remedies given in diphtheria, usually prevents the inflam- 
mation from extending into the trachea, and so cures the pa- 
tient. 

(s) APPENDICITIS. 

There is another disease that may be described as a 
sequela to acute inflammatory diseases of the intestinal 
canal, namely, appendicitis. In some instances appendi- 
citis occurs late in the fever. In such* cases the patient 
is so debilitated that an operation is unjustifiable, on account 
of the weakness already resulting from the previous fever. 
In such cases No. 55 or 5 act admirably to rid the bowels of 
retained inflammatory products, and to prevent further pto- 
maine poisoning. Hot formentations, a mustard plaster, iodine 
and glycerine, or some other soothing application, are required 
to allay the pain until a free action of the bowels has occurred. 
Then sufficient morphia sulphate should be given hvpodermi- 
cally, or, if irritable stomach, morphia, one-quarter and bis- 
muth subnitrate five grains per mouth may be given to quiet 
the stomach and subdue the inflammation. If the stomach 
remains very irritable, eight ounces of a .9 per cent, salt solu- 
tion should be given as an enema every four hours, in order 
to keep up a normal isotonic condition of the blood and to pre- 
vent thirst. The patient will usually recover from this attack. 



CHAPTER XL 



COMPLICATIONS. 



(a) Congestion of the Brain. 

(b) Acute Nephritis; Acute Palio-Myelitis; Acute Urae- 
mia, Typhoid Pneumonia. 

(a) CONGESTION OF THE BRAIN. 

The deeper, underlying structures than the meninges are 
usually involved in the complications of this type of slow 
fevers ; therefore, inflammation or congestion of the brain, 
is a better name than meningitis. 

Symptoms. This type of inflammation of the brain, 
where the inflammation is transmitted through the vaso-motor 
centre and by reflex irritation from the bowels, is evidenced 
by the zigzag temperature and pulse rate and by the marked 
difference in many cases of the internal and external tempera- 
tures. There is an extremely bad facial expression, and when 
the bowels seem extremely hot the head seems extremely cool, 
and vice versa. The rapi'd come-and-go temperature is a spe- 
cial characteristic in this disease. In fact, there may be a va- 
riation of the pulse of ten to thirty beats, and of the temper- 
ature of from two to four degrees within thirty minutes. And 
there may be a variation of from three to nine degrees be- 
tween the internal and external temperature. These symp- 
toms usually follow a severe inflammation of the bowels. 

Prognosis. The prognosis of these cases are usually 
good, provided that due attention be paid to the diet, stomach, 
and provided proper remedies are administered in these cases. 

Preventive treatment. In order to prevent this compli- 
cation, due attention should always be paid to the inflamed 
condition of the bowels, which has already been described. 
And great caution should always be used in giving purgatives. 
In some cases the brain is primarily affected. 

(122) 



Complications. 123 



General treatment. In order to lessen the blood pressure 
in the brain and internal organs, No. 13 may be given as di- 
rected. However, in these cases the internal and external 
temperature should be carefully watched, so that not too much 
blood be thrown toward the periphery. For, as previously 
stated, veratrum being a vaso-motor constrictor, will cause 
the blood to flow more or less rapidly toward the periphery. 
The temperature and pulse rate in these cases will lose their 
zigzag nature if the veratrum and other remedies are acting 
as they should do. And, in order to increase the action of the 
vaso-motor nerves, friction baths of warm or cold water with 
soda may be tried. The nearer the internal and external tem- 
perature approximate each other, the better is the patient 
doing, and vice versa. A cold cloth on the head and a warm 
one over the hypogastric region often have a salutary effect 
on the patient. If veratrum does not drive the blood toward 
the periphery in sufficient amount to cause an equilibrium be- 
tween the external and internal temperatures, then aconite may 
be tried. But if by the too frequent use of these remedies the 
blood should be transferred to the periphery to such an ex- 
tent that the external temperature is from four to seven de- 
grees higher than the internal temperature, then a vaso-dilator 
as digitalis should be used. Cold water may first be used also; 
but if the desired results are not obtained, hot water may be 
tried. Xow, it must be remembered that the bowels are moved 
only with the greatest difficulty. In such cases the calomel 
is contraindicated. Unfavorable indications are — the moving 
of the bowels only with difficulty; zigzag temperature and 
pulse rate ; great variations between the internal and external 
temperatures ; the constant changing of the bowels and brain 
from hot to coldness, and the still more severe symptoms of a 
rising pulse with a falling temperature, or vice versa. In the 
milder forms of this type, where the temperature by mouth 
and under axilla are normal, there is vertigo and flushings 
and palness of the face at irregular intervals. 

Prognosis. The prognosis is good in these cases if prop- 
erly treated. 

Treatment. In all these cases, where every appearance 



124 Typhoid and Other Fevers. 

of the patient indicates a higher temperature than he really 
has, both the external and internal temperatures should be re- 
corded. As veratrum and nitro-glycerine are vasoconstric- 
tors, they are indicated when the internal temperature is much 
higher than the external temperature ; but in forty-eight to 
ninety-six hours if No. 13 or 54 does not drive the blood toward 
the periphery, thus causing equilibrium between the internal 
and external temperatures, then No. 15% may be tried. And 
since the bowels is sluggish, calomel is contraindicated. 
Therefore, Nos. 5 or 55 may be given, with eight ounces of 
.64 per cent, of warm chloride of soda solution every four 
hours. In giving No. 13, 54 or i^Ay car e must be taken so 
as not to drive the blood too rapidly toward the periphery, for 
then the external temperature per axilla may be from three to 
nine degrees higher than the internal temperature. In such 
cases No. 11 should be substituted for veratrum or aconite. 
Fortunately the increased amount of blood toward the per- 
iphery seems to give rest to the heart. For this reason- only 
medium doses of digitalis should be given, and friction baths 
to aid the vaso-motor system should not be given oftener than 
from three to four hours. In this way types of this kind may 
be brought to a successful termination within fourteen days. 
Strychnia in any form should always be given with extreme 
caution. No. 55 should be given two or three times daily for 
a week after equilibrium is established between the internal 
and external temperatures. [The author has learned since 
writing the above that often only strychnine with warm friction 
baths with paregoric and bismuth may rapidly cause an equili- 
brium of internal and external temperature in these cases.] 

Clinical case No. 23. On September 3, 1907, Mrs. S. was 
taken with a distinct rigor, followed by an intense flushed face 
and vertigo. She would have regular periods of paleness and 
flushing of the face. And the flushing of the face would be 
followed by vertigo. She had been taking purgatives for 
some time; but I gave her No. 1 as directed, and Nos. 18 and 
13 were given- But her bowels acted with difficulty. Her 
temperature in axilla and mouth was 99. The temperature 
and pulse would drop every morning below normal, and the 



Complications. 12$ 



temperature would rise to 99 or 99 2-3, with pulse 72 to 80 
every evening. Observing the difficulty in getting a free ac- 
tion of the bowels, she was given No. 55 every three hours for 
seventy-two hours, and No. 11 in one-half size doses was ad- 
ministered every four hours. Within ten days the vertigo 
had disappeared, and the expression of the face became 
normal. 

Clinical Case No. 24. On August 5, 19 — , ., was taken 

with a distinct chill, followed by a rapid rise in the temperature. 
The temperature per mouth was 106 3-5 and pulse 142. He 
had a bad expression in the face and a general bad appear- 
ance. He was given Nos. I, II and 18 for four consecutive 
days, when his temperature per mouth was normal and his 
pulse was only 70. Though I observed at the time that he 
had a bad facial expression and a listless, inattentive look, 
however, I unwisely ordered them to report if the patient did 
not get along all right. Seventy-two hours later the father 
reported that he w T as not doing well. On my arrival I took his 
temperature per mouth, and the temperature was only 99 1-5 
and pulse J2. But he had such a bad facial expression 
and seemed so desperately ill that I took his temperature per 
axilla, which registered 105. Hoping to drive the blood from 
the brain, which seemed to be congested, I unwisely ^ave him 
No. 13 every two hours, and gave him No. 1 every two hours. 
with No. 18 before meals. On the following morning his tem- 
perature per mouth was 944-5 and per axilla the temperature 
was 104 4-5. Then cold sponge, friction baths were admin- 
istered every three hours, while Nos. 18 and 11 were given as 
directed. On the succeeding day his temperature per mouth 
was 96 and per axilla 98 1-5. The baths were omitted, and 
strychnia sulphate 1-30 gr. with one teaspoonful doses of alco- 
hol were given every four hours. Within forty-eight hours his 
internal and external temperature were 98 3-5 and his pulse 
was 72. Though he still had the bad facial expression, and 
seemed to be almost semi-unconscious, I again unwisely or- 
dered the father to report within forty-eight hours. At that 
time he reported that his son was doing nicely. I then per- 
mitted a poached egg to be given every morning. Then sev- 



120 Typhoid and Other Fevers. 



enty-two hours later I was sent for in great haste, with the 
sad news that the patient seemed to be in a dying condition. 
On my arrival the temperature per mouth was 95, per axilla 
100, and pulse was 66. He was having severe cramps in the 
bowels, most likely due to the eggs taken twenty-four and 
forty-eight hours before. I ordered an enema to be given at 
once, and strychnia, morphia and atropia in small doses were 
given, and a large dose of castor oil was taken; but the patient 
died eighteen hours later, before the bowels had ever moved. 

If I had taken the external as well as the internal temper- 
atures, if I had paid closer attention to him from the very be- 
ginning, by visiting him daily, and had not permitted him to 
take the tgg, his life might have been saved. 

Clinical case No. 25. On September 10, 1907, D. H. was 
seized with a distinct chill, followed by a rapid rise of tempera- 
ture. Within six hours his temperature per mouth was 106 2-5 
and pulse 160, and his temperature per axilla was 101 4-5. 
The face was intensely pale and anxious, and the extremities 
were cold. He was given as directed in one-half size doses 
Nos. 54, 18 and 5. Within forty-eight hours he was all right. 

Clinical case No. 26. On November 4, 1907, at 9 A. M., 
J. R. was seized with a distinct chill, which was rapidly fol- 
lowed by a rapid rise in bodily temperature. His temperature 
slowly declined until the following morning he was seized with 
a rigor, followed by the exacerbation, stationary and declin- 
ing stage as on the preceding day. On November 7th, at 1 
P. M., I was called on to see the patient, and found him in a 
semi-conscious condition. His internal temperature per 
mouth was 106 and per axilla 102 and his pulse 144. But on 
taking his temperature every twenty minutes for six hours his 
internal and external temperatures zigzagged from 100 to 106. 
Realizing that he was threatened with inflammation or con- 
gestion of the brain, he was given No. 5 every three hours, No. 
18 before meals and No. 13 as directed. This treatment was 
continued for seventy-two hours, when his internal and ex- 
ternal temperatures registered normal. He was ordered to 
take No. 18 before meals, No. 54 in one-quarter size doses, and 
Beef, Iron and Wine for a week. The patient fully re- 
covered. 



Complications. 127 



(b) ACUTE NEPHRITIS. 

Acute Nephritis is a common complication in all forms 
of fevers on account of the great amount of poisonous mate- 
rial that must necessarily pass through the kidneys. 

Symptoms. There is always more or less decreased nor- 
mal flow of urine. 

Treatment. In order to prevent nephritis, purgatives are 
always beneficial. Diuretics, as Xos. 9, 10, 11, 12 and 54, are 
always beneficial. Also frequent friction baths and enemas 
are essential in preventing or treating this common complica- 
tion. Peach tree leaf or bark poultices or onion poultices in- 
crease the urinary flow and aid in relieving the nephritis in 
98 per cent, of the cases. 

CHRONIC NEPHRITIS. 

Chronic nephritis may result from an* acute attack ; but 
usually it makes its appearance insidiously without any pre- 
vious symptoms. The mother informs the physician that the 
infant leaves a stain on the cloth every time it urinates, or. if 
a child, it leaves a stain in the bed chamber. On examination 
of these patients, usually more or less albumin is present. 

Treatment. Give No. 54 in proportional doses every two 
hours for forty-eight hours ; then four times daily for three 
or four days longer. After this time Xo. 54 should be given 
for a month in only one-third size doses. Xo. 1 may be given 
for three or four consecutive days, when Xos. 5 or 54 in suffi- 
cient doses to move the bowels once or twice daily should be 
given for another week, and Xo. 18 in proportional doses 
should be given as directed. In addition to this treatment, 
Fowler's Solution, Tincture of Iron and Basham's Mixture 
should be given in proportional closes for four to six weeks. 
Usually at the end of this time the urine is normal. But if not 
normal the treatment should be continued until it is normal, 
even if it takes from two to six months. 



128 Typhoid and Other Fevers. 

(c) ACUTE POLIO-MYELITIS. 

This disease is due to the absorption of poison while suf- 
fering from inflammation of the several layers of the intestinal 
walls, together with the undue irritation of those vaso-motor 
and sympathetic nerves in the intestinal canal that have their 
centres in the spinal cord. 

Symptoms. The patient in most casess is seized with a 
distinct chill, rigor or hot stage, which is soon followed by 
rapid rise in temperature. In rare cases the disease is ushered 
in with convulsions. The most characteristic sign early in 
this disease is the extreme drowsiness produced in these cases. 
And usually when the patient goes to sleep the temperature and 
pulse rate begin to rise. There is always a bad facial expres- 
sion and an anxious, frowning countenance in these cases. 
The pulse usually is exceedingly rapid from the very beginning. 
The bowels are usually tender and swollen. There is usually 
more or less tenderness along the spinal cord. The bowels for 
the first few days are moved with great difficulty; but an un- 
accountable diarrhoea usually occurs four to six days after 
the onset of the disease. If the patient is not cured within 
two or three weeks, paralysis of the extremities usually super- 
venes. And if the disease is not checked, the inflammation 
may extend to the cerebrum, thus causing cerebro-spinal men- 
ingitis. The temperature may reach 106 or 107, and the pulse 
may be in adults 150, in children 170 to 180, and in infants 
from 190 to 240. The bowels are usually swollen and tender. 

Differential diagnosis. This disease may easily be dis- 
tinguished from the other types from the extreme drowsiness 
produced in this type. However, there is one disease that 
closely resembles this disease in many particulars, namely, 
acute peri-hepatitis and hepatitis. In hepatitis there is usu- 
ally a dull or sharp pain in the region of the liver. This pain 
is absent in polio-myelitis. Then there is one special, charac- 
teristic sign to distinguish acute hepatitis from all acute in- 
flammatory diseases of the alimentary canal, and this diag- 
nostic feature is the remarkable fact that on account of the 
torpidity of the liver, even very early in the disease the 



Complications. 129 



temperature will rise while the pulse is falling, or vice versa, 
when purgatives or fever drops are given, while this is not 
seen early in any other disease, except in meningitis. 

Treatment. Nos. 5 or 55 should be given as directed for 
seventy-two hours; Nos. 13 and 18 should be given as di- 
rected. In many of these cases calomel may be cautiously 
given for the first three or four days. In order to prevent 
further ptomaine poisoning and nephritis, enemas of a half 
pint of .64 per cent, of warm chloride of soda solution may be 
used every four hours, and warm friction soda water baths 
may be given every four hours. If there should be too scanty 
secretions after the first three or four days, then one-eighth 
drop doses of fluid extract of ipecac or Xo. 38 may be given 
every three or four hours. Hot fomentations and poultices 
as in the disease already described should be placed on the 
patient's bowels. Late in the disease, when the secretions are 
not lessened in amount, atropia sulphate in proportional doses 
may be given. In all those cases where convulsions have oc- 
curred, or when threatened with convulsions, veratrum in pro- 
portional doses with nitro-glycerine should always be given. 
But we shall treat these forms under the head of acute 
uraemia. 

Clinical case No. 27. Mr. M.'s little child was seized with 
a hot stage, November 4, 1901. Soon the child had a tempera- 
ture of 106 and pulse 150. She was given as directed No. 1 
for forty-eight hours and No. 13 in twenty-drop doses for 
ninety-six hours. The patient was then given No. 55. She 
completely recovered within a week. 

Clinical case Xo. 28. In March, 1897, before the vaso- 
motor and capillary systems were so well understood, I was 
called to a child aged two years. His temperature at the 
time was 105 and pulse 130, and he was drowsy, indeed. He 
had a bad facial expression, and had an intensely anxious ap- 
pearance, and had labored breathing. I gave him Nos. 11, 
18 and 1 as directed. On the following day his temperature 
was 105 and pulse 134. He was given Nos. 11, 18, and bis- 
muth five grains with atropia sulphate 1-600 and strychnia 



130 Typhoid and Other Fevers. 

sulphate 1-180 every two hours. This treatment was con- 
tinued for four days longer, when, not being any better, Dr. 
M. was called to see the child. At that time the pulse was 
150 and temperature 105 2-5. Nos. 1 and 11 were given, and 
alcohol in ten-drop doses was given every two hours, to- 
gether with atropia and strychnine. This treatment was con- 
tinued for seventy-two hours. At this time the temperature 
was 106 and pulse 220. And he had paralysis of the lower 
extremities. Unfortunately we continued this treatment forty- 
eight hours longer. By that time he was completely paralyzed, 
excepting the respiratory muscles. I became convinced that 
the alcohol and atropia had assisted in causing this paralysis. 
Therefore, I withdrew the atropia and alcohol, and gave him 
No. 1 for forty-eight hours ; also aconite in one- fourth minim 
doses was given for a week, when he was given tonics. 
Within ten weeks the patient had fully regained the use of all 
of his muscles. No doubt but our treatment augmented the 
inflammation or congestion of the spinal cord. 

Clinical case No. 29. In 1905, Mary A., five years of age r 
was seized with a cold stage, which was soon followed by 
rapid rise of bodily temperature. Her temperature was 104 
and pulse 120. I gave the patient Nos. 11 and 1 for forty- 
eight hours. Then I found her temperature 105 3-5 and pulse 
160. She gave the history of being extremely drowsy. Re- 
alizing that the absorptior of the poisons was setting up an 
inflammation of the sp.'nal cord, she was given Nos. 1, 18 and 
13 ; and a four-ounce enema of warm .64 per cent, of chloride 
of soda solution was given every four hours. This treatment 
was continued for four successive days. By that time the bow- 
els having become loose she was given bismuth salicylate two 
grains, with ten-drop doses of listerine every three hours. No. 
1 was omitted, and No. 55 every four hours was substituted for 
the calomel. After forty-eight hours all medicines were with- 
drawn except the bismuth and listerine. A mild enema every 
twenty-four hours was given also. Within seventy-two hours 
the pulse and temperature had fallen to normal. Then Ba- 
sham's Mixture and No. 18 in proportional doses were given 
for a week. The patient by that time had fully recovered. 



Complications. 131 



(d) ACUTE URAEMIA. 

Acute uraemia is much more common than is usually sup- 
posed to exist. 

Symptoms. The patient is usually seized with a cold 
stage, or he may be seized with a violent convulsion. The 
pulse is usually full and bounding in character, but the pulse 
may be slow or it may be extremely rapid. The temperature 
in some cases is extremely high, but usually where the onset 
is ushered in with a convulsion the temperature is normal, or 
even subnormal. There is usually heard in the chest an asth- 
matic or stertorous breathing, being similar to the sounds heard 
in the lungs in malarial hemoglobinuria or puerperal eclamp- 
sia. I first diagnosed these convulsions as due to uraemic 
poisoning rather than due to meningitis, from the fact that 
asthmatic breathing identical with the sounds heard in puer- 
peral convulsions were usually present in these cases. And 
another special characteristic of acute uraemia is the strong, 
rapid, bounding pulse. In one case, an infant six weeks old, 
the pulse was so strong that a pulse of 340 was easily counted 
by me, and another patient the pulse was 288. It is true that 
albumin is always present in these cases, but unfortunately it 
is with extreme difficulty that urine is collected from infants. 

Prognosis. The prognosis is good. 

Mortality. The mortality in these cases is about one or 
two per cent. 

Treatment. Fortunately we have a remedy that is par 
excellence in acute uraemia, namely, Norwood's tincture of 
veratrum viride. Give Nos. I, 18 and 13 as directed; and 
give one-sixth grain of calomel every fifteen minutes until 
six doses have been given, in order to get the bowels 
to move freely. As soon as the fifteen and thirty-minute 
doses of veratrum have been given, then in order to get a 
more free diuretic action of the kidneys, Xo. 54 may be sub- 
stituted for No. 13. In many of these severe cases still larger 
and more frequent doses of veratrum are required to check 
and prevent other convulsions. If the patient is unable to 



132 Typhoid and Other Fevers. 

swallow, medicines should be administered hypodermically, or 
the hypodermic injections should be given any way in all the" 
severest forms where convulsions return every few minutes. 
In order to prevent sudden death in these desperate cases, it is 
absolutely necessary to push the veratrum until the patient 
is pulseless, for then the convulsions will in this way be 
prevented from returning. After veratrum has caused the 
patient to be pulseless he is soon revived by hypodermic 
injections of strychnia 1-30 and atropia sulphate 1-150 gr. 
every ten to fifteen minutes until the pulse returns at the wrist. 
As acute uraemia, is due to ptomaine poisoning, absorption of 
other poison and a lack of the isotonic conditions of the 
blood that cause urea to enter the blood; a free action of the 
bowels and kidneys and a pint of a .9 per cent, solution of 
warm chloride of soda water may be given as an enema per 
rectum every three or four hours. Veratrum should never 
be given unless nitro-glycerine in 1-200 grain doses is. com- 
bined with it ; and children in proportional doses. In this way 
even the most desperate cases will be cured in 98 or 99 per 
cent, of the cases. 

Clinical case No. 30. On September 4, 1899, I was called 
in great haste to see the six-weeks-old infant of G. D. The 
infant was seized with a convulsion at 9 A. M., and had been 
having them every few minutes for two hours when I first saw 
it. The temperature was 105 and pulse 340, being very full 
and strong. In addition to No. 1. in one-quarter doses, and No. 
18 in one-fifteenth size doses as directed, it was given No. 13 
in one-sixth size doses every fifteen minutes for four doses, 
every half an hour for three doses, every hour for two doses, 
and then every two hours. That night at 9 P. M. on my arrival 
its temperature was 103 1-5 and entirely pulseless. There had 
not been present any convulsions since 5 P. M. The same 
treatment was continued throughout the night. On the fol- 
lowing morning at 10 o'clock its temperature was 101 and 
pulse 170. Nos. 1, 18 and 13 were given as on preceding day. 
At 8 P. M. its temperature was 102 and pulseless. However, 
the same treatment was continued. And on the following day 
at 9 A. M. its temperature was 100 and pulse 130. The treat- 



Complications. 133 



ment of the preceding days was continued. On the following 
day the temperature was normal and the pulse was 120. The 
little patient was discharged with instructions to use Basham's 
Mixture, Fowler's Solution, and Beef, Iron and Wine in one- 
fifteenth size doses. It soon fully recovered. 

Clinical case A'o. 31. On the 5th day of November, 1902, 
F. G., aged three years, was suddenly seized with a violent con- 
vulsion. I saw him one hour after the onset, when he was still 
unconscious. The convulsions recurred every three to five 
minutes. Asthmatic breathing could be heard all over the 
chest. His temperature was 99 2-5 and his pulse, strong and 
bounding, was 288. He was given Xos. 1 and 18 in one-third 
size doses as directed; and No. 13 in one-third size doses was 
given as in case 28. Six hours later his temperature was 99 
and pulse 140. Then No. 54 was substituted for No. 13. On 
the following morning his pulse was 120 and temperature 
97 3"5- Nos. 1 and 18 in one-third size doses were continued, 
and No. 54 in one-third size doses was continued every two 
hours. He was discharged twenty-four hours later with 
tonics similar to case No. 28. 

Clinical case Xo. 32. On November 13, 1903, I was 
called in great haste to see Anna W ., aged ten years, who had 
been seized with a violent convulsion at 4 P. M. On my arrival 
at 6.30 P. M. I received the following history: While carry- 
ing her infant brother in the cotton field she was seized with 
a violent convulsion. As she had never had a previous attack, 
I diagnosed the case as acute uraemia. At 6.45 I managed to 
get her to take three drops of tincture of veratrum with 
1-300' grain of atropia sulphate. At this time she was so 
violent that it took three persons to hold her on the bed. The 
same size doses were given every five minutes until three doses 
were given, when only one-drop doses of veratrum with 
1-600 grain of nitro-glycerine were given every five minutes 
until 7.30. At this time her pulse began to relax, and at 7.45 
she regained consciousness. She was further given No. 13 in 
twenty-drop roses every fifteen minutes for three doses, and 
then every two hours during the night. At the same time she 



134 Typhoid and Other Fevers. 

was given No. I in full doses and No. 18 in twenty-drop doses 
as directed; and an enema per rectum of eight ounces of a .9 
per cent, of chloride of soda solution was used every six hours. 
On the following morning her temperature and pulse rate were 
normal. On inquiry I learned that her bowels had not acted 
for five or six days, and that she had not passed any urine 
for 36 hours. I had the parents to save her next passage of 
urine. I found the urine to be loaded with albumin. She was 
given No. 1 in half doses for three consecutive days, when 
No. 55 was given three times daily, No. 18 in twenty-drop 
doses was given as directed for two weeks, and No. 54 was 
given in twelve-drop doses four times daily for a week. Also 
an enema and a friction bath of warm soda water solution 
were given every twenty- four hours. At the end of a week 
nearly all of the albumin had disappeared. Then she was 
treated in the same way as in treating a chronic nephritis. 
Within thirty days there was no presence of any albumin, and 
the urine became normal in every respect. 

Clinical case No. 33. On December 8, 1907, Mary D., 
aged five years, was seized with a violent convulsion that con- 
tinued three hours. She was given No. 13 in twenty-drop 
doses every fifteen minutes for four doses; and then every 
hour. And No. 1 was given every hour for four doses. The 
temperature at the beginning of the attack was 101 and pulse 
180. During the intermittency of the convulsion her tempera- 
ture was 101 and pulse 140. However, after two hours from 
the subsidence of the convulsion, a recurrence of convulsions 
again took place with still greater intensity and duration. She 
was then given tincture of veratrum in three minim doses 
hypodermically every five minutes for eight doses; and the 
convulsion becoming, if possible, more severe, veratrum in 
five minim doses was administered every five minutes for five 
more doses, when the patient became pulseless. Immediately 
atropia 1-600 with 1-180 grain of strychnia were given hypo- 
dermically for two hours, when the pulse returned at the 
wrist. By this time the convulsion had ceased. No. 1 in one- 
half size doses was given as directed; No. 55 was also added; 



Complications. 135 



No. 54 in twenty-drop doses was given every two hours. The 
patient did not have another convulsion. During the attack 
of the last convulsion the little patient became totally para- 
lyzed on the left side, but this condition was not present 
forty-eight hours later. On the following morning after the 
convulsions she was given No. 54 in twenty-drop doses every 
four hours; No. 18 in twenty-drop doses was given before 
meals, and No. 1 in one-half size doses was given for forty- 
eight hours. And then the little patient was given for a week 
No. 54 in ten-drop doses four times daily; No. 55 was given 
in sufficient amount to move the bowels two or three times 
daily. And she was further forbidden to take any other than 
a strictly fluid diet. But at the end of a week after beginning 
the last treatment albumin was found in the urine. She was 
placed on the same treatment as described in the management 
of chronic nephritis. Within thirty days her urine was normal. 
It might be said in this connection that the same line of 
treatment will bring to a successful termination 95 to 98 per 
cent, of all puerperal eclampsias. It has been considered by 
most authorities that only those cases of puerperal convulsions 
that have a full bounding pulse should be given veratrum 
but in all cases treated by me. even if a weak, imperceptible 
pulse is present, I have used veratrum with nitro-glycerine 
without any mortality. And even in those cases where eclamp- 
sia occurs before delivery or before full term, the veratrum 
will cure and prevent the convulsions. Of course, in such 
cases, the uterus should be emptied with infant and placenta 
as soon as possible, when bad symptoms develop. In some 
cases of premature delivery, if it should happen that after 
seven to ten days abortion, miscarriage or delivery have not 
taken place, then it is well to cause premature delivery. For- 
tunately miscarriage is usually very easily brought about in 
these cases by the use of five-grain doses of quinine every two 
or three hours. 

(e) TYPHOID PNEUMONIA. 

There are other forms of pneumonia that are often erro- 
neously called typhoid pneumonia. 

Symptoms. The patient may be seized with a distinct chill 



136 Typhoid and Other Fevers. 

or rigor, or in many cases the patient is taken with a hot stage 
followed by a more or less rapid rise in the bodily temperature. 
There may not be any pain in the side, but in a number of 
cases there is more or less pleuretic pain. In many cases there 
is no cough at all, or if cough it is slight or only hacking in 
character. The respiration in the beginning is usually only 
slightly above normal ; the respiration often is labored in char- 
acter, which may be continued throughout the disease, but 
usually late in the disease the respiration becomes extremely 
rapid, being in severe cases in children as much as from 70 to 
100 per minute. In children the pulse usually soon becomes 
very rapid indeed ; as much as 220 has been seen by me. And 
the temperature is from 100 to 105 or 106; and in adults the 
pulse and temperature may be very high or very low and yet 
be a very severe type of typhoid pneumonia. There is always 
an intensely bad facial expression and a bad general appear- 
ance of the patient that will always impress the close, observ- 
ing clinician that the patient is seriously ill with some severe 
malady. Now, the fact that there is often no pain in the side, 
no cough, and not any abnormal sounds heard in the chest for 
the first three or four days will often greatly deceive the un- 
wary physician as to the exact nature of the disease. But 
there is one special diagnostic sign of typhoid pneumonia that 
I have never seen described in text-books ; and this special 
characteristic sign of typhoid pneumonia is always an infallible 
sign in all those patients that have suddenly been stricken 
with a severe illness. Now this infallible sign of typhoid 
pneumonia is not only the complete suppression of the normal 
vessicular murmurs, but the important fact that the patient's 
voice is not carried by the stethoscope or phonendoscope to 
physician's ear, for instead of the normal vocal resonant sound 
the tones of the voice are heard to come only from the mouth 
of the patient, but not through the stethoscope to the ear of 
the physician. And it must further be distinctly understood 
that this characteristic sign must always be heard over both 
lungs in young and strong individuals before such a disease 
be pronounced as typhoid pneumonia. However, when such 
a condition is found in two or more lobes of only one lung in 



Complications. 137 



the aged or in the very weak, then the pneumonia may be 
diagnosed as typhoid pneumonia. Now, this infallible sign 
is just as valuable in diagnosing other types of pneumonia even 
during the chill long before any crepitant rales are present, 
for a pneumonia chill simply signifies that blood is collecting 
rapidly in some portion of the lung; and this rapid collection 
of blood is diagnosed by the fact that even two hours after the 
onset, or sooner than this, there is total absence of the breath 
sounds, and the infallible sign referred to above is present 
over the whole affected area. An absolute, certain diag- 
nosis of typhoid pneumonia within an hour or two after its 
onset is of inestimable value in shortening the duration and 
lessening the mortality of the disease. So then typhoid pneu- 
monia is the presence of pneumonia in both lungs in the 
young and strong, or in one lung in the aged ; and this type 
is of sthenic type, not having in many cases any physical signs 
except the infallible sign already referred to. 

General consideration of typhoid pneunwnia. The more 
or less rapid flow of blood to any certain denned area of the 
body, as the kidneys or lungs, may be not inaptly compared to 
a large tract of low cotton lands, which had just been inun- 
dated with water. In such an instance, if the water remains 
up over the full-grown cotton bolls for forty-eight to seventy- 
two hours, the cotton field will be made totally worthless. Rut 
if there were a flood-gate one hundred feet deep and twenty 
yards wide to run the water away, then only slight damage to 
the cotton would result from the overflow. Just such a con- 
dition takes place in typhoid pneumonia from the rapid col- 
lection of blood in both lungs. If the blood is permitted to 
remain in the effected region, then so much damage may re- 
sult before resolution takes place that the patient may die. 
But fortunately we have a remedy that opens up the flood- 
gates and permits the blood to flow to some other portion of 
the body before much damage is done. And such a procedure 
is much safer than bleeding, from the fact that the blood is 
not lost, but is preserved in other parts of the body. Such a 
remedy that will cause the blood to rapidly flow from the 
lungs to other parts of the body is veratrum. 



138 Typhoid and Other Fevers. 

Morbid Anatomy. Not only are the different coats of the 
tissues on the internal portions of the lungs involved in ty- 
phoid pneumonia, but inflammation of the different structures 
of the alimentary canal. The inflammation of such large 
areas of tissues naturally causes such lowered vitality that 
the usual abnormal sounds in pneumonia are absent. That 
there is slight irritation of the lungs in mild cases of in- 
flammatory diseases, is evidenced by the hacking cough, 
while the post-mortem examination in typhoid and mala- 
rial fevers shows more or less inflammation of the lungs 
also. So it is only reasonable to suppose that a more intense 
inflammation of the intestinal structure may cause a still more 
intense inflammation in the lungs as is present in typhoid pneu- 
monia. Such a vast area of inflammation causes such a low- 
ered vitality that often the usual signs of pneumonia are ab- 
sent. 

General Treatment. In the majority of these cases vaso- 
motor constrictors, as purgatives and veratrum, will cause 
the blood in the congested areas to flow toward the periphery, 
provided that the walls of the capillaries and blood vessels are 
sufficiently strong not to break on being constricted. But if 
the internal resistance to vaso-motor constrictors should not 
be sufficient to avoid the bursting of the capillaries and blood 
vessels, such a fact may be detected by the failure of these 
remedies in lowering the internal temperature and pulse rate. 
In such cases vaso-constrictors must always be given with cau- 
tion. Often in such cases digitalis may be given to strengthen 
the muscular walls of the capillaries and blood vessels ; and in 
such cases diarrhoea easily takes place. In all such desperate 
cases only supportive treatment should be administered. 

Treatment. In every case seen in the robust and strong 
No. 13 or 54 should be administered every fifteen minutes 
till three or four doses are given, then every thirty minutes for 
two doses, and every hour for two or three doses ; after this 
the veratrum is to be given every two hours. But after 
forty-eight hours, if the temperature and pulse rate are not 
lessened, it should be omitted, otherwise it should be continued. 
Care should always be used to prevent the too rapid flow of 



Complications. 139 



blood toward the periphery. In order to prevent the blood 
flowing too rapidly toward the periphery the tempera- 
ture should be taken both per mouth and axilla every three 
hours. In all cases of typhoid pneumonia purgatives should 
always be given with extreme caution for fear of losing con- 
trol of the bowels. And close attention should always be 
paid to the pulse and respiration. If the pulse should con- 
tinue to become more and more frequent with veratrum, 
then digitalis may be tried, and if still more frequent add 
strychnia sulphate and atropia sulphate every four hours, and 
also alcohol in some form with ten-drop doses of turpentine in 
syrup of acacia may be given every four hours, and if the 
pulse continues to rise, some other means, as bathing or other 
remedies, may be used to lower the pulse rate, for the patient 
will most certainly die if the pulse is not kept under control. 
In some cases the pulse remains slow throughout the disease ; 
in such cases the respiration must be very closely watched in 
order to prevent it becoming too rapid. In every case of ty- 
phoid pneumonia it is absolutely necessary to keep the respira- 
tion down as low as possible. Yeratrum and nitro-glycerine 
often seem to keep the respiration down; but when it begin- 
to rise above 24 to 30, begin the use of atropia sulphate 1-150 
grain and strychnia sulphate 1-30 grain every four hours. At 
the same time as the secretions are usually lessened in amount 
in the first stages of typhoid pneumonia, atropia should be 
given cautiously in order not to cause too slow a resolution to 
take place. But at the same time during the third stage, when 
moist rales begin to appear, it is necessary to give atropia sul- 
phate in sufficient amount to prevent over-secretion, as is 
seen in a majority of the fatal cases. Strychnia sulphate is a 
good heart and respiratory stimulant, but it must be given 
cautiously where there is a zigzag temperature and pulse rate, 
and an irritable, inflamed sclerotic pulse, as is evidenced by 
an accelerated pulse rate. In treating typhoid pneumonia the 
physician should always hold clearly in mind that the inflam- 
mation of the bowels in severe form is usually present, and 
that the inflamed bowels by absorption of the poison and by 
reflex irritation may also cause inflammation of the brain, 



140 Typhoid and Other Fevers. 



polio-myelitis or follicular tonsilitis, or in severe cases diph- 
theria may occur. By having these different diseases clearly 
in mind typhoid pneumonia is always more successfully man- 
aged, for not only is the mortality lessened in number, but the 
duration of the disease is greatly lessened in severity and du- 
ration. 

Now, when there is a number of these complications and 
sequela present at one time in a patient, it is clearly evident 
that the medicines that are indicated in some of these compli- 
cations or sequela may be wholly contraindicated in some of 
the others. For this reason it is always better to pay the 
closest attention to those complications or sequela that are con- 
sidered to be the most dangerous at the time of prescribing 
the medicine. For instance, if the cough is extremely tight 
and annoying, if the bowels are badly inflamed and swollen, 
and if there is much zigzag temperature showing involvement 
of the brain, while there is only a mild follicular stomatitis 
and follicular tonsilitis, then the cough, the bowels and the 
brain may be closely attended to, while the stomatitis and ton- 
silitis may be ignored for twenty-four to forty-eight hours, 
when, if some of the complications or sequela should be in bet- 
ter condition while the tonsilitis and stomatitis were growing 
worse, then the complications or sequela may for a time be 
ignored while the tonsilitis and stomatitis are carefully treated. 
And so in this way many of the most desperate cases may be 
brought to a successful termination, and these cases, too, 
within fourteen days. In bringing these desperate cases to 
a successful termination within fourteen days, the physician 
must have the nurse to rigidly carry out minutely the physi- 
cian's every direction. And the physician must always re- 
member that the patient is getting better so long as the tem- 
perature, pulse and respiration ratio are kept in proportion 
with one another ; and he must always bear in mind the patient 
is growing worse, and so should have a change in medicine 
when there is at any time any great change in this ratio. And 
he must further remember that the pulse, temperature and res- 
piration ratio in typhoid pneumonia is entirely different in dif- 
ferent cases, both on account of the different grades of 



Complications. 141 



severity of the types and on account of the different degrees 
of vitality of the different patients. For instance, in some 
cases the temperature may be 104, pulse 90 and respiration 24; 
then in this case when the temperature falls the respiration 
and pulse should fall in the same ratio, or if the temperature 
should rise the pulse and respiration should rise in the same 
proportion. On the other hand, if the temperature should be 
only 100, pulse 124, and respiration 24, then any slight rise 
of temperature should proportionately increase the respiration 
and the pulse rate; while a slight drop of the temperature 
should cause a considerable drop in the respiration and pulse 
rate. So, by closely observing these points and by closely ob- 
serving the difference between the internal and external tem- 
peratures, the physician will be able not only to form a better 
idea as to the prognosis, but he will be able to both lessen the 
mortality and shorten the duration of the disease. The room 
in the winter time should not be too warm, but should be at 
about 60 F. The bowels should be kept under perfect control 
from the very beginning of the disease. 

Clinical case No. 34. On November 4, 1901, A. F., aged 
twenty-one, was taken suddenly with a distinct chill, followed 
by rapid rise of temperature. At 4 P. M., four hours after 
the onset, the loss of the breath's sounds and the infallible 
sign were present over the lower two lobes of the right and 
the lower lobe of the left lung. His temperature was 105 1-5. 
pulse 126 and respiration 26. Xo. 13 was given every fifteen 
minutes for four doses, then every thirty minutes for two 
doses, and then every two hours ; also Xo. 18, and, in addi- 
tion to this treatment, No. 1 every two hours was adminis- 
tered. On the following day his temperature was 105, pulse 
120 and respiration 24. He had become semi-conscious dur- 
ing the preceding night. To the treatment of the previous 
day was added Nos. 18, 44 and 62. But his bowels on the 
6th had become so loose that bismuth in five-grain doses was 
given every two hours, and Xo. 1 was omitted. This treat- 
ment was continued for seventy-two hours, when his pulse 
was 132, temperature 104 and respiration 30. No. 63. with 
one dose of No. 64, was given every four hours. On the 



142 Typhoid and Other Fevers. 

following day his temperature was 102, pulse 112 and respi- 
ration 20. In addition to this treatment, alcohol in teaspoon- 
ful doses, well diluted, was given every four hours. Within 
seventy-two hours the temperature, pulse and respiration were 
normal. He was continued on Nos. 18, 63 and 64 in one- 
third size doses, and Beef, Iron and Wine. He made a com- 
plete recovery. 

Clinical case No. 35. On November 6th, at 9 A. M., J. F., 
aged ten, a brother of case ^2, was taken suddenly ill with a 
distinct hot stage. I saw him thirty minutes after the onset. 
Even at that time the stethoscope revealed the loss of the 
breath sound and total loss of vocal resonance, and a very 
slight dullnss was observed over the affected area. The in- 
fallible sign was located over the lower two lobes of the left 
lung and upper two lobes of the right lung. The temperature 
was 103, pulse 156 and respiration 40. He was placed on 
Nos. 1, 18, 44 and 11. Forty-eight hours later his temper- 
ature was 105 2-5, pulse 170 and respiration 60. His bowels 
were moving freely, and he complained of a severe pain in 
the lower lobe of the left lung. For the pain, fomentations of 
flannel cloths wrung out of a teaspoonful of turpentine to a 
pint of hot water were applied to the chest every five minutes 
until relieved. No. 1 was omitted, while No. 19 was given 
every four hours. And No. 62 was added, as he became 
delirious. On the 10th his temperature was 105 3-5, pulse 
164 and respiration 74, and he was still more delirious than on 
the other two previous days. To the medicines already being 
administered were added Nos. 63 and 64 as directed. But 
forty-eight hours later his temperature was 106, pulse 200 
and respiration 100. In fact, he had to be held up in a sit- 
ting position in order to be able to breathe. Then No. 64 in 
proportionate doses was ordered to be administered every 
two hours. Nos. 62, 44 and 63 were given every three hours, 
and alcohol in twenty-drop doses was given every three hours. 
For the severe pain in side No. 39 was applied every three 
hours, and a hot ash or salt poultice was ordered until pain 
was relieved. On the 13th his temperature was 105, pulse 
150 and respiration 70. The same treatment was continued, 



Complications. 14? 



except warm friction baths of soda solution were ordered to 
be applied every three hours. On the 14th the temperature 
was 103, pulse 132 and respiration 40. And forty-eight hours 
later his temperature was 100, pulse 90 and respiration 22. 
Then only Xos. 18, II, 44 and 64 were given as directed. 
On the 17th his pulse, temperature and respiration were 
normal. He was continued on Xos. 64 and 18 as before, on 
Xo. 11 in half-size doses as had been given, and also Beef, 
Iron and Wine were given. He soon completely recovered. 

Clinical case No. 36. On November 6th, at 4 P. M., 
Mary F., aged eight years, a sister of the two clinical cases 
just described, was also taken very suddenly ill, without any 
pain in the side or any other physical signs that would cause 
the physician to suspect pneumonia. On physical examination 
at 6.30 P. M. I detected the infallible pneumonia sound, to- 
gether with the total suppression of the breath sounds over the 
lower lobe of the right and lower lobe of the left lung. Her 
temperature was 104, pulse 124 and respiration 26. She was 
given Xos. 1 1, 1, 18 and 44 in proportional doses. On the 
following day her temperature was 105 1-5, pulse -138 and 
respiration 32. Then Xos. 62, 63 and 64 were added. On 
the 8th her temperature was 104, pulse 124 and respiration 26. 
At this time warm, friction, sponge, soda solution baths were 
added every four hours. On the 9th, her bowels becoming 
extremely loose, Xo. 1 was substituted for Xo. 19 every four 
hours. On the 9th her temperature was 103. pulse 116 and 
respiration 24. The same treatment was continued for forty- 
eight hours, when she was discharged, with tonic treatment 
similar to the preceding cases already referred to. 

Clinical case No. 37. M. F., aged twelve years, another 
brother of Xos. ^2, 33 and 34, was taken seriously ill at 3 
P. M. on the same day that his sister was seized. I examined 
him at 7 P. M., and found with stethoscope that the infallible 
pneumonia sign was present in the lower lobes of both lungs 
and two upper lobes of the left lung. His temperature was 
105 1-5, pulse 130 and respiration 34. He was given the 
same treatment as in case No. 34; but on the following day 
his temperature was 1054-5, pulse 150 and respiration 44. 



144 Typhoid and Other Fevers, 

And he complained of a severe pleuratic pain in the pleura 
over the lower lobe of the left lung. Hot fomentations were 
ordered to be applied over the affected area, and Nos. i, n 
and 1 8 were continued, while Nos. 62, 63 and 64 were added 
in proportionate doses. On the 8th his temperature was 
1054-5, pulse 150 and respiration 48. The pain in the side 
being no better, a hot mustard plaster was placed on the 
painful area for twenty minutes; and then a hot ash poultice 
was ordered to be held over the painful region until the pain 
subsided. No. 64 was ordered to be given every two hours 
until ordered to be discontinued. Also Nos. 18, 62, 44 and 
11 were given in proportional doses. On the 12th his tem- 
perature had fallen to 100, pulse 104 and respiration 30. He 
had by this time regained consciousness. So he was ordered 
to be given Nos. 18, 11 and 64 every two hours, and No. 44 
as directed. On leaving I informed the family that probably 
I would discharge him on the following day. Unfortunately, 
I did not see the patient until 10 P. M. the following night, 
when I found the patient apparently in a dying condition. I 
could not conceive how the patient should get so much worse 
at a time that I intended to discharge him. His temperature 
was only 100, but his pulse was 162 and respiration 90. I soon 
perceived that he needed more stimulation. Knowing that I 
ordered No. 64 every two hours and alcohol every four hours, 
I could not believe that he had been taking so much stimula- 
tion ; for if he had taken these stimulants as directed, I fully 
realized his desperate situation. On close inquiry I learned 
that he hadn't taken alcohol or No. 64 for seventeen hours. 
He was ordered to take the same treatment as previous day. 
On the following day he was much better. His temperature 
was 100, pulse 120 and respiration 40. At this time I perceived 
that the lungs were not clearing up in the least. This treat- 
ment was continued for ten days, when his temperature was 
100, pulse 120 and respiration 30. Fearing tuberculosis, he 
was placed on Steam's Wine of Cod Liver Oil, Fellow's 
Hypo-phosphites with syrup of iodide of iron. However, 
unfortunately, I continued the atropia for a week. Then, 
fearing that the atropia had injured the patient on account 



Complications. 145 



of too greatly lessening the secretions, atropia was discontin- 
ued ; he made a slow recovery without any clearing of the 
lungs. As a result his lung tissues did not become normal 
until a year had elapsed. I am thoroughly convinced that the 
atropia did great damage to the patient. 

Now, all these patients were orphans, and were nursed 
by their eldest brother, who had never had any experience 
in waiting on the sick. And, to make these conditions more 
undesirable, these four patients were all huddled into three 
beds, all of which were in only one dark room, with not a 
window in the house. And it rained almost incessantly dur- 
ing their illness. Now, since the eldest brother had to give 
all the medicines, attend to the applying of all the poultices 
done, do all the cooking and sit up day and night, it can be 
more easily imagined than described how these severely sick 
patients did so well under such unfavorable circumstances. 

I am, furthermore, satisfied that had No. 13 or 54 been 
given earlier than No. II, these patients' temperature, res- 
piration and pulse rate would not have been so rapid. 

Clinical cases Nos. 38 and 39. Mary D., aged eleven, 
and Anna D., aged thirteen, were both seized with a slight 
rigor on the 4th day of January, 1901. Mary's temperature 
was 104, pulse 120 and respiration 24. Anna D/s tempera- 
ture was 102, pulse 100 and respiration 22, and both had the 
infallible signs already so often referred to. 

Treatment. The treatment was Nos. 1, 11, 18 and 44. 
Within forty : eight hours Mary's temperature was 104, pulse 
120 and respiration 130. Anna's temperature was 101, pulse 
96 and respiration 20. But both at this early time were 
wholly unconscious. There were some crepitant rales heard 
over their lungs at this time. As in previous cases I had not 
given opiates for fear of blocking up all the secretions in the 
chest. However, as they seemed so delirious, morphia one- 
quarter and atropia 1-150 gr. in quarter-size doses were given 
every two hours, and No. 62 was also added. Both became 
quiet after midnight. And Mary became conscious at 8 A. M., 
while Anna regained consciousness at 6 P. M. the following 
day. Their temperature, pulse rate and respiration rapidly 



146 Typhoid and Other Fevers. 



fell to normal. Then tonics were given as in previous sim- 
ilar cases. They both made rapid recovery. 

Clinical case No. 40. On February 4, 1903, the infant of 
J. W., aged eleven months, was seized with a sudden rise of 
temperature and pulse rate. Four hours after the onset its 
temperature was 105, pulse 150, and respiration 32. The gen- 
eral facial expression and general appearance plainly indicated 
a severe type of disease. On close physical examination the 
normal breath sounds over the upper lobe of the right and 
lower two lobes of the left lung were absent ; and the infallible 
pneumonia sign was distinctly present in these regions. From 
the sudden, rapid rise in the bodily temperature, pulse rate 
and respiration, the general bad appearance of the infant, and 
the intense prostration present in such a short time, I diag- 
nosed the case typhoid pneumonia with inflammation of the 
bowels. The little patient was given Nos. 1, 11, 18 and 44 in 
proportionate doses. But on the following day the tempera- 
ture was 105 3-5, pulse 150, and respiration 36; and the cough 
was tight and hacking in character. In addition to the treat- 
ment of the previous day calomel 1-6 grain every fifteen min- 
utes was given for six doses, friction bathing in warm soda 
water solution every four hours, and No. 62 in proportionate 
doses every four hours were ordered. On the 6th the little 
patient's temperature was 106, pulse 184, and respiration 80. 
But on inquiry I learned that the mother would not bathe the 
infant for fear of increasing the cold. And in addition to 
inflammation of the bowels and typhoid pneumonia, follicular 
stomatitis and follicular tonsilitis were now present. The 
treatment of the preceding day was again ordered. At 8 P. M. 
the same day I was called to see it in great haste. The little 
one lay with its head thrown back, eyes wide open, and tossing 
to and fro as if in a dying condition. The extremities were 
cold, the lips, ears and forehead were blue. The tonsils were 
greatly swollen, the lymphatic glands were increased in size, 
and the tongue and lips were bleeding. And the bowels and 
kidneys had not acted for twenty-four hours. Furthermore, 
on inquiry I learned that the mother had absolutely refused 
to use friction baths on her baby. I then informed the mother 



Complications. 147 



that she must follow my every direction. Therefore a nurse 
was employed to use strong, brisk, rapid friction baths of 
warm soda water solution every two hours through the night ; 
No. 1 was given every two hours with No. 54. Xos. 62, 44 and 
64 were given every three hours, they being given in such a way 
that there was an interval of one hour between the dobes. And 
in order to assist No. 54 and bathing to lower blood pressure, 
thus relieving congestion of the brain and kidneys which 
was now taking place, enemas of eight ounces of a .9 per 
cent, of a warm chloride of soda solution every four hours 
was also added ; but feeling confident that I could still 
later on successfully manage the follicular tonsilitis, stom- 
atitis, and bleeding tongue and lips, I ignored them entirely. 
For the inflamed bowels, kidneys and swollen lymphatic glands 
of the neck I ordered hot onion poultices to be frequently ap- 
plied over the stomach, bowels, and over the glands of the 
neck, and No. 39 was applied over these regions every three 
hours. The temperature under the axilla, the respiration and 
the pulse rate were taken every thirty minutes throughout the 
night, and found a variation in the temperature to be from 
101 to 105, the pulse from 140 to 210, and the respiration to 
vary from 40 to 84 within 30 minutes' time. And during the 
night the hands were in constant motion. Now, all these 
symptoms plainly indicated that congestion of the brain had 
taken place ; but the only favorable sign was the fact that the 
temperature, pulse rate and respiration all rose and fell to- 
gether. Even the mother soon became convinced that the 
friction baths were doing immense good for the patient, since 
thirty or forty minutes after every friction bath the extremi- 
ties would become warmer ; the lips, forehead, ears and finger- 
nails less blue ; the cough would become looser ; the pulse, 
temperature and respiration would become less, and the facial 
expression and general appearance would become better. On 
the 7th, at 8 A. M., the temperature was 104, pulse 138, and 
respiration 40. On taking the temperature, pulse rate and 
respiration every thirty minutes I found that the variation was 
very slight, which was of favorable import. The same treat- 
ment for forty-eight hours longer was continued, when the bow- 



148 Typhoid and Other Fevers. 



kidneys, lungs and brain were in much better condition, for 
the temperature was 103, pulse 130, and respiration 34. But 
the throat, lymphatic glands and stomach were in a worse con- 
dition. The infant then was treated as follows: No. 1 was 
omitted, and No. 25 in proportional doses with five grains of 
bismuth subnitrate was given every two hours, and the mouth 
was washed out at the same time with a boracic acid, listerine, 
lime water and glycerine wash every two hours ; No. 65 was 
given every four hours; No. 62 was given with No. 64; and 
No. 18 and poulticing were continued, and friction baths were 
given every four hours. And in addition to this treatment No. 
25 was ordered to be given every time false membrane col- 
lected in the throat, even if as frequent as every five minutes. 
With this plan of treatment the patient gradually grew better ; 
and so on the 13th the patient was discharged. At this time 
it was given syrup of iodide of iron, Basham's Mixture, and 
Nutrient Wine of Creosote in proportional doses. 

Clinical case No. 41. There are some cases of primary 
congestion of the brain that simulate typhoid pneumonia. At 
Chicago, in July, 1906, an infant aged fourteen months was 
admitted into the hospital suffering with a severe illness. It 
had been seized at 2 A. M. the same day with a severe convul- 
sion. At 4 P. M., fourteen hours after the onset, the surgeon 
in charge made a close physical examination of the little 
patient. There were found crepitant rales over the base 
of both lungs; slight dulness was also present, and there 
was present dilatation of the alae nasi. The temperature 
was 104, pulse 132, and respiration 28. On these signs the 
surgeon diagnosed the disease pneumonia. But I observed 
that the eyes when not exposed to the light were intensely 
bright, glistening and shining in character, while when light 
was turned on it kept its eyes closed. Then, too, the little 
patient's very intensely bad, anxious expression thoroughly 
impressed me with the idea that both inflamed bowels and 
inflamed lungs, even with reflex irritation, could scarcely cause 
such a deathlike appearance in such a short space of time. 
So from all these symptoms combined, I diagnosed the case as 
primary congestion of the brain. For on close physical ex- 



Complications. 149 



amination, though mucous rales were present, yet the infallible 
sign together with the loss of the breath sounds were not pres- 
ent. And so I naturally concluded that the pneumonia and in- 
flamed bowels were not the primary cause, but rather due to 
the vaso-motor nerve centre in the brain that presided over the 
bowel and lung area, being primarily involved; and thus by 
reflex irritation the irritation and inflammation were trans- 
mitted to these areas. Therefore, I recommended a treatment 
that would relieve the congestion of the brain rather than 
merely treat the result of the congestion. However, from the 
mere fact that the surgeon failed to find any micro-organisms 
present in the spinal fluid, he unfortunately diagnosed the 
case pneumonia. I was permitted to have the nurse take its 
temperature, pulse rate and respiration every twenty minutes. 
The temperature and pulse zigzagged to a remarkable degree, 
the temperature zigzagging from 102 to 105, and pulse from 
120 to 160 within twenty minutes ; while the respiration varied 
from 26 to 30 within twenty minutes. But unfortunately the 
infant was treated for pneumonia. On the fifth day from 
the onset the infant died. On post-mortem exam!nation the 
lung was found to be apparently healthy, except only slight 
inflammation of the lung tissues. But the brain was found to 
be filled with pus cells. So this case proves the ease with 
which a physician may err in his diagnosis. 

Clinical case No. 42. On the 4th day of March, at 7 
A. M., J. H., aged seven years, was seized with a severe hot 
stage. I called to see him at 1 P. M. ; his temperature was 
105 2-5, pulse 138, and respiration 22. He had a very bad 
expression in the face. On physical examination I found the 
absence of the breath sounds and the infallible sound over 
the lower two lobes of the left lung and lower lobe of the right 
lung. And I further found a diseased mitral valve. I in- 
formed the family that their boy was dangerously ill of 
typhoid pneumonia, and that he had also a crippled heart that 
made the prognosis much more grave. I gave him Nos. 1, 11, 
18 and 44. Six hours later I saw him again, his general 
facial appearance was much worse, his internal temperature 
was 105 4-5, external temperature 102, pulse 148, and respiration 



150 Typhoid and Other Fevers. 

46. At this time I detected on phonendoscopic examination 
that the second sound of the heart was rapidly growing weaker. 
Fully realizing that such great internal blood pressure on an 
already weakened heart would soon bring on a sudden collapse, 
and furthermore fully realizing the fact that the continued 
abnormal supply of blood in the intestinal canal was rapidly 
setting up congestion of the brain, as evidenced by the shining, 
glistening eyes and photophobia, I therefore fully determined 
that it was absolutely necessary not only to drive the blood 
from the internal surface of the body to lessen the severity 
of the inflammation of the lungs, the bowels, the kidneys, and 
to prevent congestion of the brain, but that it was also ab- 
solutely necessary to give a vaso-motor constrictor in order 
to lessen the work of an already overworked, weak heart. So 
with this idea in view No. 54 in one-third teaspoonful doses 
was given every fifteen minutes for four doses, every thirty 
minutes for three doses, every hour for two doses, and then 
every two hours; Nos. 18, 44, 62 and 64 were given as di- 
rected. On the following morning his internal temperature 
was 105, his external temperature 103 1-5, his pulse 140, and 
respiration 36. In order to be sure that congestion of the 
brain was not taking place, I took his internal and external 
temperature, pulse rate and respiration every thirty minutes, 
and perceived that the external temperature was gradually 
growing higher and the internal temperature lower. The 
treatment of previous day was continued for seventy-two 
hours, when the external temperature was 104 1-5 and internal 
temperature only 97 1-5, pulse 138, and respiration 28. Having 
at this time made a physical examination and found the second 
sound of the heart very distinct, and having perceived the gen- 
eral appearance of the patient doing better, I continued No. 
54 in one-half size doses every four hours, and No. 64 in pro- 
portional doses every four hours. In this way the external 
temperature remained from four to seven degrees higher than 
the internal temperature for seventy-two hours, when I de- 
cided that the blood had been left at the periphy a sufficient 
length of time for the heart to have become stronger, and I 
further decided that it would be extremely dangerous to have 



Complications. 151 



the external temperature so much higher than the internal 
temperature. This fact was indicated by the more accelerated 
pulse. For this reason I informed the family that within 
twenty-four hours there would most likely be a heart failure, 
when I should be sent for in great haste. So I withdrew all 
the medicines and hot friction baths and ordered the following : 
He was given No. 11 in twenty-drop doses every three hours, 
and cold friction soda water baths were given every two 
hours. Twelve hours later I was called in great haste to visit 
the little patient. His respiration was 80, he had a rapid, 
running pulse. No. 64 in one-third size doses was given 
every thirty minutes for three doses. Dry, brisk friction 
of the extremities was ordered continuously until the 
pulse became regular, and Elixir of Valerianate of Ammonia 
and Hoffman's Anodyne in five-drop doses, and one-drop doses 
of spirits of camphor were ordered every thirty minutes. 
Within an hour his pulse again became regular. At this time 
his temperature per axilla was 10 1 and internal temperature 
102. Then No. 11 and the ammonia and Hoffman's Anodyne 
and camphor with No. 64 were given every four hours. Warm 
friction baths were then continued for forty-eight hours, when 
his internal and external temperature, pulse rate and respira- 
tion were normal. As the lungs did not clear up as well as de- 
sired, he was given nutrient wine with creosote and guiacol, 
syrup of iodide of iron, and Beef, Iron and Wine for two 
weeks, when he had fully recovered. 

These clinical cases show just how severely ill a child or 
infant may become, and yet, by painstaking, determined, per- 
sistent effort, the little patient will recover. In fact, it is 
wholly possible to bring 98 to almost 100 per cent, of all the 
children between six and sixteen to a successful termination 
with scarcely any mortality in any disease. For within 
eighteen years the only mortality in any disease per se in 
children between six and sixteen years is the case of hem- 
orrhage of the bowels given in Clinical case No. 17. 

Veratrum may be given in all those types of disease 
where there is more or less rapid flow of blood to the internal 
organs of the body, as in the kidneys, lungs and brain. Also 



152 Typhoid and Other Fevers. 

often in severe inflammation of the bowels and liver verat- 
rum may be given, but the more especially in children, the 
robust and strong. But it should always be given with care 
to the feeble. Veratrum may be given safely so long as 
the temperature and pulse rate fall. However, veratrum 
must be given cautiously in any case in which the internal 
temperature is much lower than the external, for in such cases 
digitalis may be safely administered. 

APPENDICITIS. 

Appendicitis frequently occurs as a sequela in slow fe- 
vers. In such cases the patient is too weak to undergo an 
operation, so then medical treatment in such cases is indi- 
cated. And in many cases patients absolutely refuse to be 
operated upon. In such cases also medical treatment is de- 
manded. As the symptoms of appendicitis have been so mi- 
nutely described in so many text-books of medicine and sur- 
gery, it is not necessary to give the symptoms here. 

Treatment. Drinking water should be avoided as much 
as possible, in order not to more irritate an already irritated, 
inflamed stomach. In order to prevent thirst, enemas of 
eight ounces of a .9 per cent, of a soda chloride solution 
may be given every four hours. Thus enemas move the 
bowels, and assist in keeping an isotonic condition of the 
blood. No. 5 should be given every hour until the bowels 
move freely. During this time hot turpentine stupes should 
be retained constantly on the bowels, and equal parts of iodine 
and glycerine may be applied every three hours. As soon as 
the bowels have acted freely, if severe pains continue, then 
give morphia one-quarter and bismuth subnitrate five grains 
every three hours to quiet the stomach, allay the inflammation, 
and subdue the pain. And sweet spirits of nitre, twenty drops, 
with twenty grains of acetate of potash every four hours in 
plenty of water, may be given to lower the bodily tempera- 
ture and increase the diuretic action of the kidneys. And 
friction bathing in warm soda water solution should be used 
every four hours to reduce the temperature and pulse rate. Fric- 



Complications. iro 



tion baths in this way will often produce sleep, even when 
morphia is withdrawn. As soon as the pain has subsided, 
morphia should be withdrawn. And, in order to prevent pto- 
maine poisoning, the bowels should be moved with Xo. 5 as 
often as every forty-eight hours. In some cases fluid extract of 
digitalis may be given in three-drop doses with five-drop doses 
of Fowler's Solution every four hours. And in these cases 
a fluid diet is absolutely necessary for at least five days after 
the subsidence of the temperature. And at the crisis the tem- 
perature may drop to 94 or 95. But heart stimulants should 
be given only every four hours, so as not to overstimulate 
the patient, since over-stimulation will cause a return of the 
fever. If the temperature remains for some time below nor- 
mal, then alcohol in one teaspoonful doses may be cautiously 
added. In this way the patient will recover in 95 per cent, 
of the cases. And if the bowels should be made to move 
every day, in this way appendicitis will not often recur. 

Clinical case Xo. 43. Unfortunately, in many instances 
the pain is ushered in with such severity that the physician 
begins opiates before enema or salts are given. Then it often 
occurs that severe ptomaine poisoning results from the long- 
continued constipation of the bowels, together with the pa- 
tient being placed too early on solid food. The following 
case is one of this kind. 

Mrs. , in November, , was taken with such 

agonizing pain in the umbilical region, which soon became 
fixed, at "McBurney's Point.'' The pain was so severe and 
the vomiting so frequent that Xo. 27 was given for seven 
days to subdue the pain and quiet the stomach. Dr. S. was 
called twenty-four hours after the illness ; but her tempera- 
ture was 105 and pulse 148, and she was very plethoric. For 
these reasons she was not operated upon. At the end of 
seven days her bowels was slowly moved with Xo. 5, and 
enemas of eight ounces of a .9 per cent, of chloride of soda 
solution were given every four hours, and No. 2y was with- 
drawn. After the bowels acted her temperature fell to 
normal, while the pulse rate remained at 130. Unfortu- 
nately, she was permitted to partake of solid food. As a 



154 Typhoid and Other Fevers. 



result of the eating, her temperature rose to 104 and pulse to 
140. and she continued to eat until the pain in the hepatic 
region became so intense that she decided to take only fluid 
diet. At this time she was given only fluid diet, with eight 
ounces of a chloride of soda solution as an enema; and No. 
54 was given every three hours. Her temperature within 
ninety-six hours fell to 95 degrees and pulse to 130. But the 
temperature was 97 and pulse 130. However, No. 54 in tea- 
spoonful doses every four hours was continued four days 
longer, when her pulse was 80 and temperature 98. She was 
continued on the enema, No. 54 and fluid diet for another 
four days, when she was discharged. 

There is no doubt that, had the patient been given No. 5 
or 54 at the beginning, and had a fluid diet been given through- 
out the disease, the attack would have been much shorter. 

Inflammation of Serous Coat — Mesentery. The Serous 
Coat furnishes practically a complete covering for the whole 
tube except the duodenum, which is scantily clad with it. 
This membrane is reflected from the dorsal wall of the abdo- 
men, runs forward for a distance, and varies in different parts, 
reaching the intestines, and enwraps the intestines and returns 
almost to its line of first contact, and then turns toward the 
parietal margin, keeping in practical opposition with its out- 
going layer until it arrives at its starting-point, when it reflects 
toward the opposite side of the body. This forms a snug 
investment for the gut, and forms a double layer, being fast- 
ened at one end to the hind wall of the abdomen, at the other 
to the intestines, thus permitting large freedom of movement. 
This structure is the "Mesentery." And between its two layers 
are the arteries, veins, lymphatic vessels and nerves required 
by the bowels, a great number of lymph nodes, and usually a 
quantity of adipose tissue. The proximal (attached parietal 
dorsal border of the mesentery) extends from the left side of 
the second lumbar vertebra to the right mescolon, its direc- 
tion being from above downward and to the right mescolon, 
and its measurement being eight or ten inches. The distal or 
free border is vastly longer, extending the length of the 



Complications. 155 



jejunum and ileum. Its sides are right or superior, and left 
or inferior. 

The Lesser Omentum extends from the small curvature 
of the stomach and the adjacent first part of the duodenum to 
the portal fissures of the liver, and encloses the tubes which 
enter and leave this opening. 

The gastro-colic ("stomach-colon") or great omentum. 
This portion of the peritoneum connects the great curva- 
ture of the stomach and the adjoining first part of the duo- 
denum with the transverse colon. This omentum is far more 
voluminous than is necessary to establish a bond of union 
between the stomach and colon. It hangs downward in front 
of the small intest'nes like an apron, and carries in the in- 
terstices of its structure an amount of adipose tissue which 
varies according to the fatness of the individual. 

So in this work we shall subdivide the inflammation of 
the peritoneum into the following subdivisions: 

(x) Inflammation of Mesentery. 

(y) Inflammation of Lesser Omentum. 

(z) Inflammation of Greater Omentum. 

(z) INFLAMMATION OF THE MESENTERY. 

The inflammation of the mesentery is an inflammation 
involving the mesentery. 

Morbid anatomy. The inflammation from the muscular 
coat has involved the serous coat in this region. Not only 
are the bowels inflamed and tender, but they are soon greatly 
swollen from the involvement of the adipose tissue. 

Symptoms. Usually secondary meningitis soon may de- 
velop from reflex irritation of the sympathetic nervous sys- 
tem. The bowels soon become greatly distended and ex- 
ceedingly tender to pressure. The temperature is usually very 
high and the pulse very irritable and rapid, and the pulse and 
temperature usually zigzag on account of the rapid transfer- 
ence of the inflammation to the brain. 

Treatment. Calomel is usually contraindicated. No. 54 
may be given as directed if it lowers temperature and pulse, 



156 Typhoid and Other Fevers. 

otherwise omit. Then No. 11 may be given. And, in order 
to cause more free urination, hot fomentations, as peach 
tree leaves or bark poultices, onion poultices, other hot foment- 
ations and iodine and glycerine every three hours. If No. 54 
does not agree with the patient, then No. 11 may be given. 
As the inflammation is on the outside of the intestines, not 
inside, even salts may do harm. Therefore, some form of 
opiate is usually indicated. So give No. 22, 23, 24 or 27. 
If the stomach is weak, No. 2J is preferable. It is often better 
not to have the bowels to act more than once every three or 
four days. However, if No. 54 seems to lower the tempera- 
ture and pulse rate every time it is given, then it may be given 
every day in sufficient amount to move the bowels once daily. 
If the bowels continue to swell, opiates should be given for a 
weak and the bowels checked for the same length of time ; 
but if bowels during this time should become tympanitis, 
then castor oil should occasionally be administered. And, 
in addition to the poultices, hot turpentine stupes should 
be applied every five to fifteen minutes, and iodine and glycer- 
ine applied every hour until the inflammation is controlled. 
In addition to this treatment, No. 17 or 18 should be given 
from the very beginning. Friction baths should be given 
every one to four hours. In every case the internal and ex- 
ternal temperature should be taken at the same time. And, 
in order to aid the capillaries vaso-motor remedies should 
always be given. 

Prognosis. The prognosis is good if carefully managed 
as to diet and remedies. 

Clinical case No. 43. J. R., aged three years, was taken 
with typhoid pneumonia in 1902. On the seventh day of his 
illness he was seized with acute peritonitis, with symp- 
toms resembling meningitis. His temperature varied from 
103 to 105 and pulse from 130 to 180. The bowels soon be- 
came intensely swollen, the hot fomentations of peach tree 
leaves, onion poultices and turpentine stupes doing no good. 
The bowels continued to become more and more distended 
until a large fissure in the medium line extended from the 
umbilicus to the pubes. At this time iodine and glycerine 



Complications. icy 



equal parts were painted over the whole bowels every thirty 
minutes, applying three coats every time. And also he was 
placed on No. 23 as directed in proportional doses. The in- 
flammation rapidly subsided. Then, as soon as the fever and 
pulse rate became normal, he was placed on syrup of iodide 
of iron, Fellows' Hypophosphites and Beef, Iron and Wine. 
He made a complete recovery. 

(y) Inflammation of the lesser omentum. In this type 
of inflammation of the peritoneum an inflammation of the liver 
may occur by extension of the inflammation. 

Acute hepatitis or peri-hepatitis. Acute hepatitis or peri- 
hepatitis may be primarily involved or may be secondarily in- 
volved, the inflammation thus extending from the liver. 

Symptoms. The patient is seized with a distinct chill or 
fever. The expression of the face is very pale, anxious and 
bad. The temperature ranges from 102 to 105 and pulse from 
80 to 100. The fauces usually are clay-colored, and hard, and 
the bowels usually move with extreme difficulty. There is 
usually within three or four days a more or less severe pain 
in the region of the liver, and at this time or a few <lays later 
a dysenteric discharge may occur. 

Now the main diagnostic features cf this disease are the 
bad facial expression, the high temperature with slow pulse 
rate, pains in the hepatic region, and often dysenteric stools, 
and the still more prominent feature is the extreme difficulty 
with which purgatives move the bowels ; and the fact that 
digitalis, veratrum, aconite, bathing and purgatives, instead 
of lowering bodily temperature and pulse rate, have the oppo- 
site effect. And of still more importance is the fact that this 
disease is the only known disease (except meningitis) that from 
the very beginning may have early rising temperature with fall- 
ing pulse or vice versa. Acute hepatitis very closely simulates 
severe inflammation of the bowels and meningitis. 

Clinical case A T o. 44. Birdie H., aged ten years, July I, 
1907, was seized with a distinct rigor, followed by rapid rise 
in temperature. At 4 P. M. her temperature was 102 and pulse 
84. But she had a bad expression of the face, and a bad gen- 
eral appearance. And the tongue was bluish in color ; also the 



158 Typhoid and Other Fevers. 



eyes were glistening. The patient, my own child, impressed 
me from the very beginning of her illness that she was a dan- 
gerously sick child. Hoping to get a free action of the bowels, 
No. 1 was given in full doses as directed, but her bowels acted 
only once during twenty-four hours. And I further noticed 
that as soon as Nos. I, 11 and 18 were administered the 
temperature began to rise and pulse to fall, so that within 
eight hours her temperature was 104 and pulse 88. Then 
omitting No. 1, No. 11 was continued, but her temperature 
registered the same for eight hours. At this time, in order to 
reduce the temperature, friction soda water solution baths 
were given every two hours, which baths only increased the 
temperature. Within ninety-six hours her temperature zig- 
zagged from 106 to 104% and pulse from 88 to 96. At this 
time she complained of an intense pain in the hepatic region. 
The liver and spleen were greatly enlarged. Then Nos. 1 and 
11 were given, and friction soda water baths were given as 
directed; but the temperature continued to rise until tempera- 
ture was 106 3-5 and pulse 108. Fully realizing that these 
medicines only aggravated the trouble, they were omitted. 
Then No. 13 was given, but seemed to cause the pulse to in- 
crease, while the temperature declined somewhat. Then all 
purgatives and antipyretics were omitted and only warm fric- 
tion baths were given every two hours. But these baths after 
five days proved only to magnify the already severe symptoms. 
At this time the pain in the hepatic region became almost un- 
bearable. Iodine and glycerine were applied every two hours, 
but the inflammation extended to the pleural cavity. At this 
time, for fear of an abscess of the liver forming, I had Dr. S. 
and Dr. W. called in, who, thinking the case to be an empyema 
from the fact that the pleural cavity was swollen, the pleura 
was punctured three times to no effect. The surgeons then 
withdrew without any further procedure. The iodine and 
glycerine Were applied every hour, and the bowels were moved 
very gently with No. 54 four times daily. Unfortunately, by 
not more continuously applying iodine and glycerine early in 
the disease, and from the fact that the purgatives and fever 
drops as Nos. 11 and 54 were given too long without doing 



Complications. 159 



good, the fever continued for a month. However, we con- 
sidered it very fortunate that she didn't finally have an ab- 
scess of the liver. 

(z) INFLAMMATION OF GREATER OMENTUM. 

In this type of peritonitis not only is the serous coat of the 
intestines involved, but the inflammation also extends to the 
stomach. 

Symptoms. There is always great tenderness over the 
bowels and the stomach in this type of peritonitis. The pulse 
and temperature usually zigzag. The patient usually has in- 
cessant vomiting, which is difficult to control. The stomach 
and bowel tissues become swollen early in the disease. The 
drawn, haggard, pinched features, and the extremities drawn 
upon the bowels, all give the diagnosis of acute peritonitis. 
The zigzag temperature and pulse rate usually occur early in 
this type of acute peritonitis. 

Treatment. Hot fomentations, peach tree leaf or bark 
poultices, or onion poultices and tincture or iodine and glycer- 
ine applications over the stomach and bowels, together with 
cold cloths on the head, should be applied at regular intervals. 
At the same time hot friction baths should be applied every 
two or three hours. And medicine to quiet the stomach should 
be given until stomach becomes quiet. Such remedies are Nos. 
45, 27, 36, essence of peppermint, and mustard plaster over 
the pit of the stomach, should be administered. Then Xos. 
18, 2J and 25 may be given as directed. Xo. 13 or 54 should 
be given as directed. However, if Xo. 54 or 13 does not re- 
duce the pulse rate and temperature, or does not cause equil- 
ibrium of the internal and external temperatures, then such 
remedies should be substituted by Xos. 11 and 12. 

Clinical case Xo. 45. Mrs. D. was taken desperately ill 
at 8 A. M. on the nth day of November, 1907. She had been 
taking purgatives to no effect for twenty-four hours, when I 
saw her for the first time at 9 A. M. The temperature was 
102 and pulse 150. Her stomach was so irritable that noth- 
ing could be retained on it. Her bow T els and stomach were 



160 Typhoid and Other Fevers. 

greatly swollen, inflamed, tender and somewhat distended. 
In order to quiet the stomach a mustard plaster was placed over 
the gastric region ; one-half pint warm chloride of soda solu- 
tions was ordered every four hours in order to prevent thirst. 
No food was allowed for forty-eight hours. Nos. 45 and 36 
were given to allay the great irritation of the stomach. Hot 
fomentations were constantly applied until the irritable stom- 
ach became quiet. Then sweet spirits of nitre was given in 
thirty-drop doses every four hours to increase the action of 
the kidneys. At this time the temperature was 101 and pulse 
130. Realizing that the pulse was entirely too fast, No. 27 
was given for three days. Then the temperature was 97 and 
pulse 86. She being always a nervous individual, I rightly 
concluded that 86 was her normal pulse rate. She was given 
No. 18 and fluid extract of celery in proportional doses, and 
she was directed to eat only peptonized foods for a week. She 
soon entirelv recovered. 



SECTION IV. 



CHAPTER I. 



I shall at this place describe some other acute inflammatory 
diseases that have their seat in the intestinal canal. These dis- 
eases are: 

(A) Acute Enteritis or Entro-c otitis. 

(B) Cholera Morbus. 

(C) Cholera Infantum. 

(D) Acute Dysentery. 

(A) ACUTE ENTERITIS OR ACUTE ENTERO-COLITIS. 

Symptoms. The onset is usually ushered in with a more 
or less cold or hot stage, which is followed by rise in tempera- 
ture. The patient usually becomes drowsy, and the pulse may 
become extremely rapid. Within forty-eight hours the bowels 
begin to move more or less freely. And the severity of the 
inflammation is shown by the temperature, pulse rate., drowsi- 
ness and the frequency of the diarrhoea. 

Prognosis. The prognosis is always good if rigid direc- 
tions are carried out as to the drinking water, diet and treat- 
ment. 

Treatment. No. I should be given every half hour, fol- 
lowed by salts or oil ; and No. I in one-sixth size doses should 
also be given every fifteen minutes until six doses have been 
given; or No. i (with blue powder three grs.) should be 
given. Always give medicines to correct the faulty action of 
the stomach as No. 25, 18 or 19. Warm turpentine stupes 
should be applied on the abdomen for forty-eight hours. 
Then, if the kidneys are not secreting freely, peach tree or 
onion poultices may be applied. And No. 11 may be given also. 

(161) 



1 62 Typhoid and Other Fevers. 

, 1 , 

This treatment may be continued for seventy-two hours, when 
in many cases the patient is much better. At this time, how- 
ever, it is necessary to omit the purgative and give bismuth 
and salol every two hours. This treatment will cure seventy- 
five per cent, of the cases in this way. The cases not cured 
should be given enemas every twelve to twenty-four hours, 
the water not being held more than two feet higher than the 
patient. And No. 21 may be added to the bismuth preparation. 
Late in the disease strychnia sulphate, atropia and nitro- 
glycerine may be added. Aromatic sulphuric acid is always 
good in these cases. Then late in the disease tincture of 
camphorated opium may be given with blackberry brandy. 
But they should rarely be given early in the disease. 

(B) CHOLERA MORBUS. 

Symptoms. The patient is seized with a severe watery 
diarrhoea, the bowels acting one to three or four times every 
hour. 

Treatment. Give No. 1 or 3 every hour for five or six 
doses, followed by salts ; also give one-sixth grain of calomel 
every fifteen minutes for eight doses. Give No. 11 every 
three or four hours, and No. 18 as directed. And this treat- 
ment should be repeated. Usually this treatment will cure the 
case; but if not, then, after seventy-two hours, add paragoric, 
bismuth, aromatic sulphuric acid and blackberry brandy. 

(C) CHOLERA INFANTUM. 

Symptoms. The patient is seized with a distinct chill or 
rigor, followed by a rapid rise in bodily temperature. At the 
same time there is a severe choleraic diarrhose, the bowels 
acting two to three times every hour. The patient soon be- 
comes very drowsy. The temperature may be 105 to io6 1 /o 
and pulse from 130 to 200. 

Treatment. Give one-sixth grain of calomel every fifteen 
minutes for six doses, and give No. 1 every hour until four 
doses are given. Follow an hour after the last dose by salts, 
and repeat No. 1 twelve hours later; and still twelve hours 



Cholera Infantum. 163 



later No. 2 with two-grain doses of blue powders may be 
given. Then No. 2 may be given as directed every twenty- 
four hours for forty-eight hours, when Xo. 19 in proportionate 
doses should be given every three hours, and bismuth subni- 
trate five-grain doses should be administered. 

However, should the purgatives at any time irritate the 
bowels, as evidenced by a more accelerated pulse, higher tem- 
perature or dysentery, then they should not be given. In 
such cases No. 54 may be given. Then, after twenty-four 
hours, No. 19 may be given with five-grain doses of bismuth 
every two or three hours. And atropia and sulphate of 
strychnia may be given in proportional doses every four hours. 
Also blackberry brandy, paragoric, aromatic sulphuric acid, 
lime water, etc., may be added late in the disease. In some 
cases where the bowels remain uncontrollable No. 22, 23 or 
24 may be given in small doses. 

The essential treatment in this disease is calomel early 
in the disease, and bismuth every two hours late in the disease 
with No. 18 as directed. And atropia, strychnine* and black- 
berry brandy when the patient becomes weak late in the dis- 
ease. 



(D) ACUTE DYSENTERY. 

(a) Mild Grade. 

(b) Severe Grade. 

(a) MILD GRADE OF DYSENTERY. 

Symptoms. There is more or less mucus found in the 
discharges, which are more or less bloody in character. The 
bowels in this type do not move oftener than from four to six 
times daily. The temperature early in the disease is usualy 
not more than 101 to 103, and the pulse in an adult not more 
than 90 to 112, in a child from 100 to 120. 

Treatment. No. 1 may be given as directed for forty- 
eight hours; Nos. 11 and 18 should be given throughout the 
disease. Instead of No. 1, No. 38 may be given from the be- 
ginning. After twenty-four to seventy-two hours, No. 19 



164 Typhoid and Other Fevers. 



and bismuth should be given every two hours. Also in the 
beginning of the disease No. 5 or 54, or castor oil in broken 
doses, may be substituted for Nos. 1 and 38. In all these 
cases the patient should be given warm friction baths, and 
an enema of eight ounces of a .9 per cent, salt solution should 
be given. 

(b) SEVERE ACUTE DYSENTERY. 

Symptoms. This type is usually ushered in with a distinct 
chill or rigor, which is followed by a more or less rapid eleva- 
tion of temperature and pulse rate. At the same time a distinct 
bloody dysenteric discharge occurs. The bowels may move 
from eight to sixty times within twenty-four hours. And in 
many of these cases the discharges are nothing more than pure 
blood. 

Prognosis. In this type the mortality should not be high 
if rigid dietetic and therapeutic regime be carried out from 
the very beginning. 

Treatment. Give Nos. 55 and 38 every two hours ior 
forty-eight to ninety-six hours, when the bloody discharges 
will usually have" ceased ; and the discharges by this time will 
have been lessened in number. In addition to Nos.^8 and 5^" 
some form of medicine to increase the action of the stomach 
should always be given, as No. 17 or 18. As an antipyretic 
and diuretic, No. 11 or 12 should be given. From a theo- 
retical standpoint No. 13 or 54 might be indicated, but I have 
always managed even the most desperate cases with the treat- 
ment already given, and so have never given No. 54 or 13. 
After forty-eight to ninety-six hours have elapsed, it is then 
much safer to give No. 19 and bismuth in five-grain doses 
every two hours until bismuth is present in the stools. The 
presence of bismuth is always a favorable indication. If any 
signs of follicular stomatitis occur, then No. 45 should be 
given. After five or six days, blackberry brandy, atropia sul- 
phate and strychnia sulphate should be given. But if the 
patient should seem to be desperately weak from the begin- 
nine of the disease, then atropia, strychnine and blackberry 
brandy should be begun early. 



Severe Acute Dysentery. 165 

Clinical case No. 46. On the 7th day of August, 1901, 
J. T., aged two years, was seized with a distinct cold stage, 
which was rapidly followed by a rapid rise of bodily tem- 
perature and pulse rate. Bloody dysentery took place, 
and the bowels moved as often as sixty-four times within 
twenty-four hours. He was given No. 38 every two hours, 
and No. 11 was given in proportional doses every four hours. 
However, after seventy-two hours, the frequent bloody stools 
continued. At this time No. 19 every three hours and bis- 
muth were added every two hours without any apparent re- 
sult. Then, fully realizing that the stomach was not acting, 
No. 18 was administered. On the following day the bismuth 
was detected in the faeces. Immediately the stools became 
further apart and more in amount, until forty-eight hours 
later the blood had disappeared from the stools, and the 
bowels acted only eight times in twenty-four hours. Within 
seventy-two hours the dysentery was checked. Then atropia, 
strychnia and blackberry brandy were given in proportional 
doses. It is always absolutely necessary to use only the 
blandest foods. Buttermilk may be given, but* sweet milk 
should not be taken unless boiled, or unless lime water be 
placed in the milk. And then, if the milk curdles on the 
stomach, the milk must be omitted. 

Clinical case No. 47. On July 4, 1903, J. G., aged four 
years, was taken with a hot stage, rapidly followed by high 
temperature, pulse rate and frequent bloody dysenteric stools, 
his bowels moving forty-eight times within twenty- four hours. 
His temperature within twenty-four hours was 105 2-5 and 
pulse 138. He was given Nos. II, 18 and 54 from the begin- 
ning of the disease. He was further ordered to take only a 
fluid diet. Boiled sweet milk with lime water, having curdled 
on the stomach, it was ordered to be withdrawn. After 
ninety-six hours, the patient not being any better. No. 38 
was omitted, and No. 19 and five grains of bismuth were 
added. But forty-eight hours later, the little patient not 
being- any better, atropia, strychnine, alcohol and blackberry 
brandy were ordered. But on the following day the little 
patient was no better. Then I fully realized that something 



166 Typhoid and Other Fevers. 

desperate must be done. I questioned the mother particularly 
in regard to his diet. To this inquiry she declared that she 
had not given her little boy any food. But, fortunately, he 
had a stool while I was present. Then I discovered small 
undigested solid foodstuffs. And only then did the mother 
admit feeding her child solid food. After convincing the 
mother that her child's life depended upon her carrying out 
my directions, he was given only a fluid diet. He then made 
rapid recovery by giving Nos. 45, 19, 18, atropia sulphate, 
strychnine, alcohol, blackberry brandy and bismuth in five- 
grain doses in proportional doses. The patient gradually be- 
came better until five days later his bowels acted only once 
in twenty- four hours. Then Beef, Iron and Wine and Steam's 
Wine of Cod Liver Oil were given for a few days. 



CHAPTER II. 



CONCLUSION. 



I have treated all acute inflammatory diseases on the 
theory that micro-organisms in disease are the result of a 
faulty vaso-motor capillary system rather than the real cause 
of the disease. And, in addition to what has already been 
said in this work, in proving that micro-organisms are the 
sole underlying causes of these diseases, the following may be 
said. 

The fact that no micro-organisms cause fever in patients 
that have sufficient resistance. 

Even micro-organisms causing infectious fevers that have 
once caused a fever rarely recur ; and the fact that it usually 
requires many years before a child with a tubercular parent 
develops consumption clearly shows that there is still deeper 
underlying cause than mere micro-organisms. 

However, even were it not true that there is a great proba- 
bility that the so-called typhoid bacilli are nothing more than 
rejuvenated colon-bacilli, it is only reasonable to conclude 
that these typhoid bacilli in great numbers may be carried 
out of the system by purgatives, since they are admittted to 
have gotten into the system through drinking water. And 
since such is the case a purgative will drive them out of the 
system. 

And with all the reasons set forth to show that slow 
fevers may be broken within fourteen days is the fact that 
I have done this for so many years. Therefore such clinical 
proofs that have been set forth are no theory nor no idea, but 
an absolute fact. 

Xow, then, there is a very important point in aborting 
slow fevers or in managing any disease. And this point is 
the full determination of the physician himself that the pa- 
tient by all means must get well ; and so, having fully deter- 

(167) 



1 68 Typhoid and Other Fevers. 



mined in his own mind that the patient is going to get well, 
he can the better impress the patient that such is the case. 
And the mere suggestion to the patient that he will get well 
within two weeks or within less time will produce a wonderful 
good effect upon the patient, for in this way alone the disease 
may be often lengthened or shortened by the will-power of 
the physician alone. For many times by mere suggestion 
through strong desire alone I have been able to get a patient 
well on the day set for them to get up. Mr. Mc?s little girl 
was severely ill, temperature 105 3-5 and pulse 174. But I 
assured her that I would have her up in time to attend a 
picnic nine days later. So, in order to have her do this, on 
the fifth day of her illness, when her temperature was 103 
and pulse 124, I informed her and her mother that the child's 
temperature and pulse rate were normal; and so had her to 
dress and go to the table and eat whatever she desired. And 
I found her on the following day without any fever, and she 
attended the picnic without any return of the fever. I had 
rightly concluded that her great anxiety to attend the picnic 
had intensified her fever and pulse rate. I had formed this 
idea from the fact that, though she had a high fever and pulse 
rate, she had a good, general expression. 

The physician should usually give his opinion to the 
family as to the prognosis and duration of the disease, for 
such frank expressions from the physician will not only cause 
greater confidence in the physician, but will cause the physi- 
cian to ever be on the alert to detect any unfavorable outcome 
so as to prevent it, or a favorable termination so as to inform 
the family of this fact. In this way, by such close, interested 
observation, the physician will become more skillful in de- 
tecting favorable or unfavorable symptoms in disease. It is 
true that in the beginning of a young physician's experience 
he will often err in his opinion ; but he can simply say that, as 
he didn't know everything, he may sometimes be mistaken in 
his opinion ; that, however, if his opinion was wrong, he pre- 
ferred to speak candidly rather than pretend to know more than 
he really did. Such candor will naturally inspire the physi- 
cian to study every phase of disease, in order not only to be 



Conclusion. i5q 



able to form correct diagnosis, but also be able to more and 
more nearly foreknow not only the prognosis as to the mor- 
tality, but also be able to foretell the duration of the disease. 
For it is just as necessary for the physician to be able, by his 
knowledge and clinical experience, to give the prognosis and 
duration of the disease as it is for the surgeon to inform his 
patient of the prognosis of the case and duration of his illness 
after the operation; and it is not only just as necessary, but 
also just as possible for the physician to be able to give an 
accurate prognosis and duration of the disease as it is for the 
medical examiner of a life insurance company to be able to 
inform such company whether or not the applicant would live 
out his expectant life period; for if a physician is able to cor- 
rectly determine whether or not the applicant has the consti- 
tution to live out his expectancy, then in the same way he 
should be able by close physical examination and objective 
symptoms to perceive whether or not the patient has the con- 
stitution to withstand the disease. For, in addiion to the phys- 
ical examination and objective symptoms, the physician may 
more safely depend upon the subjective symptoms than when 
examining an applicant for a life insurance. And it is fur- 
ther just as necessary for the physician to have the fullest 
confidence in the ability to accomplish such a full knowledge 
of disease as it is necessary for a business man to have full 
confidence in his own ability to carry out successfully any 
gigantitc enterprise. For as it is with the business man so it 
is with the physician, that he must first conceive these things 
possible before he will diligently pursue through patient, un- 
tiring toil in order to be master of the situation. In order to 
be able to become more and more skillful in aborting disease 
and lessening mortality, the physician should keep a record 
of every important case that he has. And then every case 
that dies or continues longer than fourteen days he should 
write under criticisms as the years go by every error in the 
management of the case, and such criticism should be writ- 
ten in red ink. Such criticism will be of material aid to the 
physician in avoiding the same errors. 

It is true that this work, even from a clinical standpoint, 



170 Typhoid and Other Fevers. 

is not without error, but I have deeply desired to lay down 
some broad, general ideas, upon which may be founded some 
practical basis for scientific study from a practical, not theo- 
retical, standpoint. And so, in order to stimulate further sci- 
entific and clinical research, I propose to make the following 
awards: To the one sending me the best typewritten manu- 
script, bearing out the ideas set forth in this work, I shall 
award such person three per cent, of the net proceeds that the 
author derives out of this work up to January, 1914. And to 
the one sending me the best typewritten criticism on the ideas 
set forth in this work, I shall award such person three per 
cent, of the net proceeds derived from this work up to Janu- 
ary 1, 1 9 14. And I shall honorably mention five of those 
persons giving the next highest per cent, in each of these dif- 
ferent manuscripts presented. 



CHAPTER III. 

GENERAL EXPLANATIONS. 

It has seemed necessary to give some of the formulas 
that many years of practical, clinical experience have conclu- 
sively proved to be very efficient in the different phases of 
disease in this work. 

Now, in this work it will be noticed that the writer often 
says as directed. This simply means that the medicine should 
be given as directed, to be given under the given formula. 

I have learned from many years of clinical experience 
that Young's rule in prescribing remedies to children is very 
efficient. His rule is as follows : Add the age to twelve, and 
then divide the age by the result. For instance, if the infant's 
age were one year, then the dose would be ' ia - =1-13; if 
two, then 2 ^ i2 =1-7, etc. But if an infant is under one 
year I find the following to be a very efficient rule : Since the 
average weight of an adult is 150 pounds, and since an infant 
is much weaker constitutionally than an adult, then, in order 
to get the average dose of an infant under one year, one-half 
the weight of an infant is divided by 150. For instance, if the 
weight of the infant is ten pounds, then 5-150— 1-30 equal the 
size of the dose; if sixteen pounds, then 8-150=1-19, or 1-9 
of a dose, etc. 

Then it must be remembered that opiates may be grad- 
ually increased in adults until remarkably large doses may be 
given. But it must be further remembered that children do 
not bear proportional large doses of opiates in any form, while 
they bear much larger proportional doses of calomel. In fact, 
they seem in many cases to bear as large doses of calomel as 
adults. And in the same way they seem to bear proportional 
larger doses of purgatives than adults ; this fact should always 
be remembered in administering calomel. And it should fur- 
ther be distinctly remembered that in treating children the 
formulas referred to should always be given in proportional 

(170' 



172 Typhoid and Other Fevers. 

closes as referred to, except that calomel may be given to 
children in three times the proportional dose, while opiates 
should not be given in more than one-third size doses. 

It is true that these formulas are not, from a clinical and 
synergistic standpoint, placed together properly, but from a 
clinical, practical standpoint they answer every purpose 
claimed for them, and for this reason are very efficient in les- 
sening mortality and shortening the duration of the disease. 

I shall further add that these remedies should always be 
prepared only by chemists of world-wide reputation. 



FORMULARY. 



Xo. 1. 

R Hydrarg. chlor. mite gr. j Xo. 8 

Salol gr. xij 

M. Ft. chart, no. iv. 

Sig. : One dose every one and a half hours until four doses are 
taken. Follow two hours after the last dose by castor oil, salts, or some 
other mild non-irritating cathartic. Repeat the same for two days in 
succession. But if the bowels should move more than four or five 
times before giving the third or fourth dose, then omit giving t 
doses, but give the oil, salts or other mild cathartic any way. And 
omit giving the powders at any time that there is present any mucous 
or dysenteric material in the discharges. 

Xo. 2. 

In these cases where there are dysenteric discharges : *vhere Xo. 1 
has been given for more than three or four conscutive days : where 
there is severe pain in the abdominal region ; or where it seems to be 
too dangerous to administer Xo. 1. then Xo. 2 may be given. 

B Hydrarg. chlor. mite gr. j Xo. 8 

Bismuth subnitrate, 

Cerium oxalate, 

Pepsin. 

Salol aa gr. xij 

M. Ft. chart, no. iv. 

Sig. : Administer one powder every one and a half hours until four 
doses are given. Follow one and a half hours after the last dose by 
castor oil, salts, or some other mild cathartic. 

Xo. 3. 

B Hydrarg. chlor. mite gr. xiv 

Pulv. rhei gr. viij 

Podophyllin, 

Santonin aa gr. ss 

Bismuth subnit gr. viij 

Salol gr. xij 

M. Ft. capsular no. iv. 

Sig. : Take one capsule every two hours until four doses are taken. 
Follow two hours after the last dose by salts, or castor oil, or some 
other mild cathartic. 

(173) 



1/4 Formulary. 



No. 4. 

B Pulv. rhei, 

Bismuth subnitrate aa gr. viij 

Podophyllin gr. ss 

Salol gr. xij 

M. Ft. capsular no. iv. 

Sig. : One capsule every two hours until four doses are given. 
Follow two hours after the last dose by oil or salts. 

No. 5. 

Ifc Na. phosphate, 

Mag. sulph aa ad Biv 

M. Sig. : One teaspoonful with ten drops of dilute nitromuriatic 
every three or four hours, until bowels move freely. 

No. 6. 

B Fluidextract taraxacum q. s. ad Biv 

M. Sig. : One teaspoonful four times daily for chronic enlarge- 
ment of the liver. 

No. 7. 

R Chiomia q. s. ad Bviij 

M. Sig. : One teaspoonful four times daily for chronic enlarge- 
ment of the liver. 

No. 8. 

I£ Fluidextract digitalis f 3ss 

Kalii citrate 3ss 

Fowler's solution f 3ss 

Sweet spirits nitre f 5ss 

Kalii acetate 3ij 

Aqua q. s. ad Bij 

M. Sig. : One teaspoonful with three grains of salol every three 
hours when any fever. 

No. 9. 

I£ Fluidextract digitalis mxxxvj 

Fluidextract belladonna m\\] 

Fowler's solution f 3j 

Sweet spirits nitre f 3ss 

Aqua q. s. ad l'\) 

M. Sig. : One teaspoonful with three grains of salol every three 
hours when any fever. 

No. 10. 

B Fluidextract digitalis mxxxvj 

Fluidextract belladonna wiij 

Fluidextract nux vomica f 3ss 

Fowler's solution f3j 

Sweet spirits nitre f oss 

Aqua q. s. ad oij 

M. Sig.: One teaspoonful with salol every three hours when 
anv fever. 



Formulary. 175 



No. 11. 

ty Fluidextract digitalis wilxxij 

Fluidextract belladonna miv 

Fowler's solution f3ij 

Sweet spirits nitre f 3j 

Kalii citrate 3j 

Kalii acetate 5ss 

Kalii bromide 3iij 

Aqua q. s. ad Si v 

M. Sig. : One teaspoonful with three grains of salol every three 
or four hours when any fever. 

Xo. 12. 

I£ Fluidextract digitalis mlxxij 

Fluidextract belladonna mv\ 

Fowler's solution f3ij 

Sweet spirits nitre f 3j 

Fluidextract mix vomica f 3 j 

Kalii citrate 5j 

Kalii acetate 3ss 

Kalii bromide 3iij 

Aqua q. s. ad 3iv 

M. Sig. : One teaspoonful with three grains of salol every three 
or four hours when any fever. 

Xo. 13. 

R Tr. veratrum viride /nxxx 

Nitroglycerin tablets Vioo No. 3 

Aqua q. s. ad 3ij 

M. Sig.: One teaspoonful every fifteen minutes for three or 
four doses. Then every two hours. 

Xo. 14. 

R Tr. veratrum viride wxxxvj 

Fluidextract belladonna ;//iij 

Xitroglycerin tablets H.io Xo. 3 

Syrup simp., 

Aqua aa q. s. ad Sij 

M. Sig. : One teaspoonful every hour for three doses, then two 
hours. 

Xo. 15. 

R Tincture aconite 7/?xij 

Kalii bromide 3j 

X"a. salicylate 3i 

Sweet spirits nitre f 5ss 

Aqua q. s. ad oij 



M. Sig. : One teaspoonful every hour. 



A 

176 Formulary. I 

No. isy 2 . / 

B Tr. aconite mxi j 

Kalii bromide, 
Kalii iodide, 

Na. salicylate aa. 3j 

Sweet spirits nitre f 5j 

Glycerin, 

Syrup simp., 

Aqua aa. q. s. ad Sij 

M. Sig. : One teaspoonful in water every two hours when any 
fever. 

No. 16. 

Ifc Fluidextract gelsemium ; mxxiv 

Kalii bromide 3iss 

Sweet spirits nitre f 3j 

Aqua q. s. ad Bij 

M. Sig. : One teaspoonful every two hours when any fever. 

No. 17. 

B Pepsin, sacch 3ij 

Ac. mur. dil f3ij 

Elix. lactated pepsin q. s. ad Siv 

M. Sig. : One teaspoonful in water before meals. 

No. 18. 

B Pepsin, sacch 3ij 

Ac. nitromur. dil f §ss 

Elix. lactated pepsin q. s. ad §iv 

M. Sig. : One teaspoonful before meals. 

No. 19. 

B Pepsin, sacch., 
Bismuth subnit., 

Cerium oxalate aa 3 j 

Salol gr. xxxvj 

M. Ft. chart, no. xii. 

Sig. : One powder before meals, when the bowels are too loose or 
the stomach is too badly deranged. 

No. 20. 

B Aromat. sulph. ac 3ij 

Bismuth subnit, 

Pepsin, sacch aa 3 j 

Aqua calc, 

Listerine, 

Glycerin, 

Syrup simp., 

Aqua aa q. s. ad 3iv 

M. Sig. : Two teaspoonfuls every four hours. 



Formulary. 177 



No. 21. 

R Tr. camph. opii ovj 

Bismuth subnit., 

Pepsin, sacch aa 3ij 

McCabe's B/B brandy q. s. ad 5iv 

M. Sig. : One teaspoonful every four hours. 

No. 22. 

Ifc Bismuth subnit 3j 

Salol, 

Powder, Dover aa gr. xxxvj 

M. Ft. chart, no. xij. 

Sig. : One powder every three or four hours. 

No. 23. 

Ifc Bismuth subnit 3j 

Powder, Dover 3ss 

Plumbi acetate gr. xl 

Salol 3ss 

M. Ft. chart, no. xij. 

Sig. : One powder every three or four hours. 

No. 24. 

I£ Pulv. opii gr. vj 

Plumbi acetate gr. xxiv 

M. Ft. chart, no. vj. 

Sig. : One powder every four hours. 

No. 25. 

I£ Ac. borac 3j 

Pepsin, sacch., 

Kalii chlorate aa 3j 

Ac. carbol wvj 

Listerine, 

Aqua calc, 

Glycerin, 

Syrup, simp., 

Aqua aa q. s. ad oiv 

M. Sig. : One teaspoonful every three hours. 

No. 26. 

R Tr. f erri chlor 3i j 

Ac. borac 3j 

Ac. carbol mvj 

Kalii chlorate 3j 

Listerine, 

Aqua calc, 

Glycerin, 

Syrup, simp., 

Aqua aa q. s. ad 5iv 

M. Sig.: One teaspoonful every three or four hours. 

12 



178 Formulary. 



No. 27. 

IJ Morphia sulph. tablets gr. l /± No. 6 

Bismuth subnit 3j 

M. Ft. chart, no. vj. 

Sig. : One powder every two hours when necessary. 

No. 28. 

3 Morph. sulph. tablets, 

Atropia Hoo tablets aa gr. y A No. 6 

M. Sig. : One tablet of each every two hours when pain or cannot 
sleep. 

No. 29. 

1^ Tr. ferri chlor., 

Fluidextract eucalyptus, 
Fowler's solution, 

Fluidextract ergot aa, f 3ij 

Fluidextract digitalis wxxxvj 

Fluidextract nux vomica f3j 

Fluidextract belladonna my] 

Syrup, simp., 

Glycerin, 

Aqua aa q. s. ad Biv 

M. Sig. : One teaspoon ful four times daily. 

No. 30. 

I£ Quinine sulphate 3ss 

Cayenne pepper gr. vj 

M. Ft. capsulae no. xij. 

Sig. : One capsule every two hours when no fever. 

No. 31. 

Ifc Kalii bromide 3iss 

Aqua q. s. ad Bij 

M. Sig. : One teaspoonful with every dose of any form of 
quinine. 

No. 32. 

R. Hydrobromic acid q. s. ad §ij 

Sig.: Give in fifteen-drop doses with every dose of quinine. 

No. 33. 

B Quinine sulphate 3j 

Aromatic sulphuric acid 3ij 

Syrup verba santa, 

Syrup licorice comp aa q. s. ad §ij 

M. Sig. : One teaspoonful every two hours when no fever. 



Formulary. 179 



Xo. 34. 
R Warburg's tincture q. s. ad 5ij 

M. Sig. : Half-ounce at a dose. Repeat in three hours, all fluids 
being omitted until three hours after the last dose. 

Xo. 3s. 

R Yinotone Q- S. ad lv- 

M. Sig. : Three teaspoonfuls from every two to four hours. 

Xo. 36. 
R Pulv. charcoal 5 gr. tablets Xo. 6 

M. Sig.: One tablet in a wineglassful of water; and of this 
give one teaspoon ful every fifteen minutes to quiet the stomach. 

Xo. 37. 

R Bromidia q. s. ad I) 

M. Sig. : Fifteen drops every two hours to cause sleep. 

Xo. 38. 

R Syrup ipecac nxxx 

Tincture orange-peel f5ss 

Xa. bicarb 3ii 

Tincture strophantus f5j 

Syrup, simp., 

Glycerin, 

Aqua aa q. s. ad Si j 

M. Sig.: One teaspoonful every two hours. 

Xo. 39. 

R Tr. iodine 3v 

Glycerin q. s. ad 5ij 

M. Sig. : Apply with a feather on the affected area every two 
hours. 

Xo. 40. 

R Alcohol q. s. ad 3iv 

M. Sig. : One teaspoonful well diluted every hour. 

No. 41. 

R Atropia sulphate %o Xo. 4 

Strychnine sulphate ] .;., No. 8 

Nitroglycerin tab. 1 i,;.» Xo. 2 

Elix. val. am q. s. ad 3j 

M. Sig. : One dram with Xo. 40 as directed every two hours 
when too weak or when sweating too much. 



180 Formulary. 



No. 42. 

B Fluidextract gelsemium mxxiv 

Tinct. aconite raxi j 

Kalii bromide 3j 

Fowler's solution f 3ss 

Sweet spirits nitre f 3ij 

Kalii citrate 3ss 

Kalii acetate 3i j 

Aqua q. s. ad Sij 

M. Sig. : One teaspoonful every two hours when fever; and only 
in half-size doses when slight fever. 

No. 43. 

Ifc Tr. ferri chlor fSss 

Fowler's solution f3ij 

Kalii citrate 3j 

Kalii acetate, 

Sweet spirits nitre aa f Si j 

Aqua q. s. ad Siv 

M. Sig. : One teaspoonful every three or four hours. 

No. 44. 

Ifc Am. muriate 3iij 

Fluidextract ipecac miij 

Syrup Tolu, 

Glycerin, 

Syrup, simp., 

Aqua aa q. s. ad Siv 

M. Sig. : One teaspoonful every three or four hours for cough. 

No. 45. 

fy Ac. borac 3ss 

Ac. carbol miij 

Cerium oxalate 3ss 

Bismuth subnit., 

Pepsin, sacch , aa 3ss 

Ess. peppermint «;xx 

Aqua calc, 

Aqua aa q. s. ad Sij 

M. Sig. : One-half to one teaspoonful every hour to quiet the 
stomach. 

No. 46. 

fy Tr. gentian, 

Tr. columbo aa 3i j 

Quassia chips 3j 

Tr. orange-peel Sj ^ 

Fluidextract ipecac wij 

Glycerin, 

Aqua q. s. ad Siv 

M. Sig. : One teaspoonful in water after meals. 



Formulary. 181 



No. 47. 

B Fowler's solution f3j 

Fluidextract belladonna miij 

Fluidextract digitalis mxxxvj 

Sweet spirits nitre f 3iv 

Aqua q. s. ad 3ij 

M. Sig. : One teaspoonful every three hours. 

Xo. 48. 

fy Tr. veratrum viride mv 

Atropia sulph. tab. V^o, 

Nitroglycerin tab. Vaoo aa No. 1 

M. Ft. chart, no. j. 

Sig. : Give a dose hypodermically every one to two hours in 
severe cases. 

No. 49. 

B Fluidextract digitalis f3ss 

Fowler's solution f3j 

Kalii acetate 3ij 

Kalii citrate 3ss 

Sweet spirits nitre f 3iv 

Fluidextract ipecac wtij 

Kalii bicarb 3j 

Syrup orange-peel f 3ss 

Aqua q. s. ad 3i j 

M. Sig.: One teaspoonful with three grains of salol every three 
hours for fever, when the stomach is very irritable. 

Xo. 50. 
R Hvdrarg. chlor. mite gr. 1 No. 8 

Salol, 

Powder, Dover aa gr. xij 

Pepsin, sacch., ^ 

Bismuth subnitrate, 

Cerium oxalate aa gr. viij 

M. Ft. chart, no. iv. 

Sig. : One powder every two hours. Follow two hours after last 
dose by salts, oil or some other mild cathartic. 

No. 51. 
Ifc Fluidextract digitalis, 

Kalii citrate aa 3i j 

Kalii acetate 3iij 

Kalii bicarb., 

Am. muriate aa 3n j 

Syrup Tolu 5j 

Fluidextract ipecac miij 

Glycerin, 

Aqua calc, 

Aqua simp., 

Aqua aa q. s. ad 5iv 

M. Sig.: One teaspoonful every three or four hours. 



182 Formulary. 



No. 52. 

B Atropia sulphate M.50» 

Strychnine sulphate ^o aa No. 6, 

Elix. val. ammo 3j 

Alcohol q. s. ad Bi j 

M. Sig. : Twenty drops in water every two hours. 

No. 53. 

R Atropia sulphate tab. %50 No. 3 

Nitroglycerin tab. M.00 No. 2 

Strychnine sulphate tab. %o No. 3 

M. Ft. chart, no. xij. 

Sig. : One powder every three hours. 

No. 54. 

■fy Tr. veratrum viride wxxxvj 

Fowler's solution f3j 

Kalii bicarb 3ij 

Sweet spirits nitre f 5ss 

Kalii citrate 3ss 

Nitroglycerin tab. %oo No. 4 

Aqua, 

Glycerin, 

Syrup simp aa q. s. ad Bij 

M. Sig.: One teaspoonful every two hours. 

No. 55. 

I£ Na. phosphate, 

Mag. sulphate aa 3i j 

Ac. mur. dil 3ss 

Aqua q. s. ad Siv 

M. Sig. : One teaspoonful every hour until the bowels move 
freely. 

No. 56. 

B Febrilene, 2 grains to the teaspoonful. .q. s. ad Biv 

M. Sig. : One teaspoonful every two hours for children when no 
fever. 

No. 57. 

B Fowler's solution f3iij 

Tr. ferri chloride fSss 

Sweet spirits nitre f Siss 

Kalii bicarb Sss 

Kalii citrate 3j 

Kalii acetate 3vj 

Aqua calc, 

Aqua destill aa q. s. ad Biv 

M. Sig. : One teaspoonful every four hours unless it irritates the 
stomach, then lessen the dose one-half. 



Formulary. 183 



No. 58. 

R Fowler's solution f3ij 

Sweet spirits nitre f 3j 

Aqua q. s. ad 3i v 



M. Sig. : One teaspoonful every three hours. 



No. 59. 

R Pulv. Dover gr. xij 

Na. bromide 3ss 

Salol gr. xij 

M. Ft. chart, no. vj. 

Sig. : One powder every four hours. 



No. 60. 

ty Fowler's solution 3i j 

Tr. f erri chlor 3i j 

Fluidextract nux vomica 3j 

Aqua q. s. ad Si v 

M. Sig. : One teaspoonful four times daily. 



No. 61. 

R Menthol gr. ,ij 

Ac. carbol ;//ij 

Spirits camphor mv 

Albolene q. s. ad 3ij 

M. Sig. : Apply in nasal cavity every hour if necessary. 



No. 62. 

B Spts. turpentine Sss 

Syrup acacia 3ij 

Aqua q. s. ad 3iv 

M. Sig.: One teaspoonful every four hours when cough. But if 
it causes any difficult or painful urination, then omit. 



No. 63. 

B Am. iodide. 
Am. bromide, 

Kalii citrate a a gr. xlvii j 

Syrup simp., 

Glycerin, 

Aqua aa q. s. ad oiv 

M. Sig. : One teaspoonful every four hours as a stimulating 
expectorant. 



184 Formulary. 



No. 64. 

R Atropia sulph. M.50 tablets, 

Strychnine sulph. y 30 tablets aa No. 8 

Sig. : One tablet of each every four hours. 



No. 65. 

B Tr. veratrum viride mxxiv 

Na. salicylate, 

Kalii bromide aa 3iss 

Kalii iodide 3j 

Fowler's solution f 3j 

Kalii citrate 3ss 

Sweet spirits nitre Sss 

Syrup simp., 

Aqua calcis, 

Glycerin, 

Aqua aa q. s. ad 5ij 

M. Sig. : One teaspoonful every four hours. 



INDEX. 



PAGE 

Appendicitis 121 , 138 

Congestion of the Brain. Acute 122 

Cholera Morbus 162 

Conclusion 167 

Cholera Infantum 162 

Diphtheria . . . v 115 

Diuretics faXAjS**£A* . U LvJC/JUkV. ^v^-78 

Dysentery. Acute U -M-0-&M fi JU*aJ*j •• • ^-a- 163 
Enteritis, Acute ^WW^y^^ 161 

Explanations, General I 172 

Formulas 17; to 182 



Gastritis, Acute ^^£&i*vi^Q(fo 115 

Haemoglobinuria .^XjQoYvUo.ffXv^LJ 35 

Hepatitis, Acute ^. nx^ftcv^^^^^ " U • r^^f^- • l S7 
Nephritis, Acute ?. . . XT^{ 4 U ■ J(M** / *-ty*} 2 7 






ute . .. . x. . *j ...*/. ^>u: 

tTs, Acute ^.(l^iJlftU^/vtvw^ 
ite .5 a iv^yOjvJUWjO^i^V 



Uraemia, Acute JL ty-wA^ jUuEAju^s/V 131 

Clinical Effect of SomeCo.mmox Remedies 131 

Aconite 74 

Ammonia and Ipecac jS 

Arsenic 76 

Atropia Sulphate 75 

Calomel 70 

Digitalis Q. . . .^ 71 

Magnesia Sulphate . .^rvAj(X^ 7 1 

Xitro-Glycerine 75 

Purgatives 70 

Soda Phosphate 71 

Sparteine Strophanthus. etc 72 

Strychnine Sulphate y^, 

Ouinine Sulphate J7 

185 



I 86 Index. 

PAGE 

Veratrum Viride 72 

Vaso Motor Capillary Systems 1 

Isotonic Solutions 5 

Laws of Diffusion 4 

Osmotic Pressure 5 

Vasso-Dilator Constrictor Nerves 2 

Malaria 8 

Etiology 8 

Air Theory 8 

Mosquito Theory 10 

Mosquito Malarial Cycle of Development 10 

Malarial Parasites that Sporulate but do not Form 

Crescents 11 

Quanfan Parasites 11 

Tertian Parasites 11 

Malarial Parasites that Sporulate and Form Crescents . . 11 

Pigmented Quotidian Parasites 13 

Unpigmented Quotidian Parasites 14 

Malignant Tertian Parasites 14 

Merozoites ; Perozoites 15 

Malarial Fevers — Intermittent Fevers • • • \ • • a? A 2 °- 

Quartan Intermittent ^V^. .^J.Q-^y. .V/rt^X^/?-* . . . 20 

Clinical Case A ./ry. fy "lift k m ' ' 20 

Tertian Intermittent Fevers jj? . fJ.QJi .[^JgJijJL/v . ~ . 2^ 
Benign Tertian Intermittent Fevers/lAwWi ^r. JvOu* .CJW/K323 

Severe Tertian Intermittent Fever sJq^v-^ ft . 1 1 ^. . . J ./ 24 

Clinical Case No. 2 26 

Clinical Case No. 3 <<7\. . ./j. . . .^ R . . (jA . . . 27 

Quotidian Intermittent Fevers ^W^j . {JJAwA/ir. jj 2& 
Bening Quotidian Intermittent Fevers ^R/M- i^xX^.GJJi^K©^ 
Severe Quotidian Intermittent Fevers^..;.*.-".'..'. .. 1 ....../ kg 

Acute Congestive Quotidian Intermittent Fevers 31 

Intermittent Malarial Anticipating 38 

Quotidian Intermittent Malarial Anticipating f\ 38 

Tertian Intermittent Malarial Anticipating^/^ 3$ 




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